Show:
Medicare Basics
HIPAA/Auth/PHI
Documentation
PCP CHANGES
Demographics
100
*Person I choose from each team* True or False : Medicare is health care insurance for people who are healthy between the ages of 35-45
FALSE
100
*I choose someone from each team* How do we authenticate a caller (member)
Name DOB ZIP Humana ID or Medicare ID or Billing Acct Number
100
My Choice : When documenting calls, we need to document everything that is Impactful and _____
Actionable
100
Mentor: When making a PCP change, this letter needs to go in front of a PCP number that is only 6 digits long
V Mentor: PCP change in CI
100
Mentor Demographics need to be verified every ______ days
90 days
200
Mentor: This option of Medicare offers Medicare beneficiaries plan options like (HMO, PPO, PFFS) and is ran by Private Insurance companies and sometimes offers extra Value added service coverage.
Medicare Advantage Plans Mentor: Medicare Advantage Plans
200
Mentor Give me an example of PHI
Various Answers Mentor: PHI overview
200
Mentor When viewing the contact history, linked inquiries can be viewed as an attachment where?
The Audit Trail/ Attachments
200
Mentor Name one of the necessary questions that we ask a caller during a PCP change
Various answers Mentor: Probing Questions
200
Mentor: This key is used to "pop" a county code open while changing an address
What is F10
300
*Each team nominate a person* This option, also known as Medigap is sold by private companies and helps pay some of the health care costs that Medicare does not.
Medicare Supplement
300
Mentor Can POA type U make plan changes?
Mentor: POA Types and allowed actions
300
Mentor Name one thing that you cannot write in your notes
Various answers
300
Mentor According to the mentor document we use for a PCP change, how many days do we tell a member it will take to receive their ID
14 calendar days Mentor : PCP change in CI
300
Nominate a person from your team What is the name of the Humana approved website used to verify an address
USPS
400
Mentor This choice, administered by private health insurance companies like Humana helps Medicare beneficiaries obtain drug coverage
Prescription Drug Plans Mentor: Prescription Drug Plan
400
Mentor What must a caller have on file with Humana with a deceased member to be able to receive PHI
An EOE
400
Mentor This shows us what drives the call, what is the name of the Mentor document that shows all possible options.
Inquiry Driver Codes
400
Can a medicare Louisiana member call in on the 2nd of the current month, and have her new PCP effective retro-dated back to the 1st of the month?
Mentor: CAS PCP Change Market Specific
400
I nominate someone from each team This form is used every time a residential address is changed in our systems
What is the AVF
500
What is the name of the enrollment period that allows members to disenroll from an MA plan and return to Original Medicare between January 1st - February 14th
Medicare Advantage Disenrollment Period Mentor: Medicare Advantage Disenrollment Period Overview
500
Team Choice nomination How do we authenticate a pharmacy?
NPI Name Title Name of pharmacy
500
This mentor document helps you to select a Category, Reason, and Disposition. (BE SPECIFIC)
MEDICARE CCP CRD JOB AID
500
Mentor When entering a new PCP in CI for a member, this letter needs to be written to activate the new PCP
A Mentor: PCP Change in CI
500
This document is used to verify if a member has moved out of the service area
2014 Individual Customer Number Grid