VOB
Authorization
Turn-Around Time
Plan Premium
Late Enrollment Penalty
100

How will you quote medical equipment?

DME (Durable Medical Equipment)

100

If a provider is calling and they need assistance with initiating an authorization for a procedure. Which department should you transfer?

Provider queue

100

What is the TAT for sending an ID card?

5-7 Days without delays
10-14 with delays

100

If the member wants to pay for their monthly premium. What are the payment methods that they can use?

Credit Card, Checking Account, Bank Account, Coupon Book % Social Security Account

100

If the member wants to dispute the LEP on her account, what are our options to assist the member?

Attestation and Reconsideration

200

If a member is asking how much is the copay for diabetic shoes, How will you quote this benefit to find its corresponding copay?

Diabetic Care > Diabetic Shoes

200

Do advanced imaging services require an authorization?

Yes

200

What is the TAT for medical authorization?

14 days

200

If the member has penalties on her account. What do you think that means?

She has a late enrollment penalty

200

How long is the grace period for the member to process an attestation and reconsideration?

90 Days since the initial letter date
60 Days starting from the date the Attestation expired.

300

How will you quote the procedure cataract surgery?

Surgery Services

300

Does Home Dialysis require an authorization?

No

300

What is the TAT for expedited authorizations?

72 hours

300

How many days can you advice the member to wait in case there are delays on their payment?

2-5 business days

300

How long is the processing time for Attestation and Reconsideration Request?

Attestation: 7-14 Days
Reconsideration: 90 Days

400

The member is asking if Humana offers a service to get a ride from her address to the Doctor's office. How will you quote this benefit?

Transportation

400

Which department processes the authorizations for medical services?

Clinical Intake Team (CIT)

400

What is the standard TAT for mail service?

7-14 days

400

If the member says that they paid their premium through their checking account and there are no payment that got through with Humana. What can you advise the member to do?

Ask them if their bank managed to clear the check and finished the transaction and how many days has passed by since that happened

400

How do we resolve the call if the member wishes to process a reconsideration?

Gather a sup tag and refer the member to the C2C Innovative Solutions Inc.

500

How do you quote injections?

First Ask probing questions and check where does it fall under.
Possible answers:
* Part D Medications
* Part B Medications
* Surgery Services
* Immunizations
* Vaccines

500

If the member's authorization was denied, Which department can you connect the member/provider to?

Grievance and Appeals Department
500

What is the TAT for the reconsideration to be finished?

90 Calendar Days

500

If the member claimed that they paid their premium, yet none shows on their account. What should you do?

Send the case to the billing department requesting for a payment recovery.