Words do Matter
"Our Member"
"Your Patient"
BONUS** What do each part cover?
Part A- Hospital
Part B- Medical
Part C- MA plans
Part D- PDP plans
When a provider calls in what information should be taken to authenticate?
NPI & Name
What information is needed to complete a provider search?
distance
zip code
Plan type
Search Category/Name Specialty or Condition
What is the name of the Humana incentive program that awards members for healthy living and staying active?
Humana Medicare Go365
"We can help you manage your patient"
"We can offer services you may find helpful in the care of your patient. We can offer programs that may support your treatment plan."
What age must a member be to be eligible for Medicare? What is the exception?
65 years or older.
Under 65 if they have ESRD
To authenticate a member, what information is required?
Need 2 of the following:
Member ID, Name, DOB, Zip code, group name, number or product type
What detail should you always choose before searching for a provider?
Accepting new patients
What are 2 MSBs available ONLY to PPO members?
US Travel Benefit and Worldwide Coverage
"Enable, empower, allow"
"Assist, help, support"
What is the name of the handbook Medicare members receive yearly to guide through Medicare guidelines?
Medicare and You
If a provider is inquiring about a pended claim what information must you get?
Need BOTH date of service and treating physician name
Name 3 Filter options
Patient Types Practice Focus Accepting Patients
Gender
Clinical Quality Languages Spoken
Cost Efficiency Accessibility
Specialty Hospital Privileges
Provider Type Accreditation and Certifications
Affiliations
How many meals with Moms Meals allow to members who have been discharged from Inpatient stay?
2 meals per day for 7 days up to 14 meals
limited to 4xs a year
"We partner with you. Lets work together"
"We can support you. We can work with you."
Name the enrollment period members use when they are first eligible for Medicare
IEP- Initial election period
If a provider is wanting authorization status, what pieces of information are required?
Date of Service, Rendering physician or hospital, Service provided
No physician finder plus only houses our contracted providers
Truhearing offers coverage for hearing aids 1 ear per year, what does the purchase include?
1 fitting and 2 adjustments, 3yr extended warranty and 48 batteries per aid
"Provider education"
"Providing information to support the care of your patient."
Part B - covers flu shots, screenings, physicals exams etc.
What information cannot be disclosed?
Any information pertaining to another provider
What can you do if a provider wants you to send them provider contact information for the member?
click 'send contact information' an email will be sent to the provider
What is included with Ride health?
24 one way non emergency trips by car, van, wheelchair accessible vehicle
max allowed travel distance of 50 miles per trip