HIPPA
Caller comes in authenticated in softphone and interaction log says authenticated, what do we need to verify?
Name, and thats it!
What system do we use to verify copays?
DEBUT
What policy type will always require a referral from PCP?
HMO
What link allows us to send new ID Cards and check status?
ID Card Management
What link do we click to access ebilling in CRM?
Member Billing Profiles
POA is calling on behalf of member, where do we locate POA information in CRM?
Hippa Forms on Person Account page.
What needs to be verified on every benefits call?
If preauthorization is required.
What link in CRM populates current auths on file?
Authorizations/Referrals
What do we need to verify before sending out any document or ID Card?
Address!
Where do we go to request a new Coupon Book for the member in ebilling?
Payment Method History
Agent is calling to update demographics, where can we verify the agent?
Agent contacts quick link.
What resource listed in DEBUT can help with finding resources to help the member?
Community Resources
What is the mentor we use to verify if a preauth is required?
PAL
What is the classification/intent for a member who received a letter/call?
Communication-got a letter/call
True or False: LEP will populate in Ebilling as a premium owed?
True
Who has the authority to request demographic change?
Member/ Power of Attorney/ Executor of Estate/ Agent
What system do we use to verify if a DME is covered?
In DEBUT using the CMS Database 280.1 link
What is the name of the Humana team that handles preauths?
Clinical Intake Team (CIT)
What system do we use if we cannot locate a call or letter in RTI Communications?
EMME
Member calls in stating they got a bill from their provider and needed to speak to billing...what do we do?
Transfer to claims.
What can you go over with a caller without verbal consent?
Which of the following is NOT considered a Medicare covered dental service?
A) Fracture of the jaw or facial bones
B) Routine extractions
C) Extraction of teeth to prepare for radiation treatment
D) Setting fractures of the jaw
Routine Extractions
Using your mentor, does Physical Therapy require a preauth and what is the vendor who handles that?
Yes and Cohere Health
Where do we transfer if the member has questions about an EOB/ Smart Summary?
Claims
How long is a member responsible for a Late Enrollment Penalty?
Lifetime or while member has Medicare Part D