SALES
What must we do in order to gain a better understanding of the caller's needs/wants?
Suitability assessment/Asking probing questions
TRUE OR FALSE...
Agent is setting up an appointment for husband and wife, along with their neighbor Linda. Agent is only required to qualify one prospect.
FALSE!! ALL interested parties must be fully qualified.
Are we allowed to ask directly “Are you on Medicaid or receiving state assistance?”
No, considered profiling. Use wording on disclosures grid DMS 245
*Only to be read when there's a DE-SNP in the area*
What disclosure is important to use in order to obtain a prospect's Medicare eff dates, LIS status, Etc...
Marx Disclosure
What Humana product do we receive the most allegations?
MAPD PPO
True or False...
If caller states that they do not want to hear about all plans, we do not need to list all plans in the available in the area.
TRUE! This is the only exception.
Otherwise, Agent must list ALL plans available in their area.
What are the mininum required core benefits when presenting a plan?
Plan name
Premium
PCP/SPC Copay
Hosp Copay
Rx coverage
Disclosing a member's date of birth is a violation of what?
Disclosing any sort of PHI (Protected health information) is considered a HIPPA Violation.
Is the LIS disclosure on the application, required to be read for prospects who are not receiving Extra Help?
Yes for ALL applicants regardless of their status.
*All blue highlighted areas are required to be read verbatim on the application.*
*DAILY DOUBLE*
What are the five payment method options that the prospect is given for an mapd enrollment?
Automatic Account Deduction
Social Security Deduction
Railroad retirement board benefit check
Automatic Credit Card
I want to pay humana directly/coupon book
Name one of the areas that Humana is looking at when rating clinical quality with our providers?
The effectiveness of treatment that a member receives such as:
1.How often patients are readmitted from a hospital stay.
2.How often patients develop complications after surgery.
3. How often appropriate testing and treatment are ordered by the physician.
If CS sends you a member and you ask “Has the caller been fully authenticated and verified?” once it is transferred to you, how do you verify the member?
The agent reads name, address and telephone number to the member and asks if these are correct. If affirmative, move on.
What does CTM stand for?
Compliant Tracking Module
What is currently the most commonly missed disclosure?
Permission To Continue/SOA
Who currently represents our team for quality support and what is quickest way to get InTouch with him?
Nick Munoz!!! The easiest way to get InTouch with him would be... our team chat!!!
What is the definition for NEADS analysis?
Enjoy - What do you enjoy about your plan?
Add - What would you add to your plan?
Decisions - Who makes your healthcare decisions?
Summarize/Solution - Summarize based on needs and present personalized solution.
How many qualifying questions are there for an MAPD?
There are currently 5 qualifying questions.
Medicare Parts A+B
Decision maker
Permanent Residence
Other coverage/Retirement benefits
Election Period
*DAILY DOUBLE*
What is the expected score for the compliance section in our QA evaluation?
90% or above
When enrolling a member into the Humana Honor PPO plan, what is one of the common disclosures that we are not required to read?
Late Enrollment Penalty or Part D statement
These disclosures are not required to read for prospects enrolling into a MAPD that does NOT include prescriptions.
*However it is important to educate the caller about the LEP incase they were to optain pdp coverage in the future.
*SCENARIO*
Prospect receives Medicare parts A+B and pharmacy coverage from the VA and is inquiring about one of our MAPD Plans.
Will this prospect be subject to a late enrollment penalty?
No.
Since the caller is receiving pharmacy coverage through the VA, it is considered credible coverage thus not being subject to a penalty.
*DAILY DOUBLE*
What percentage is the sales section worth of the evaluation score?
It is worth 30% of the evaluation score.
Name the hierarchy of enrollment periods when two or more election periods overlap.
1. IEP/ICEP
2. OEP/OEP NEW
3. SEP
4. AEP
5. OEP-I
*This is the recommended hierarchy, however CMS does specify that the election period that is more advantageous for the prospect should be selected.
What is the difference between a CTM and a Section A Allegation?
Section A is an Allegation not coming from Medicare but when a member files a complaint to Humana.
CTM’s are when a Medicare beneficiary files a complaint with Medicare. Much more serious.
CTMs affect our star ratings with Medicare.
*DAILY DOUBLE*
Must the permission to discuss DE-SNP disclosure be read verbatim?
Yes.
*You will only receive the double points if you were able to quote it verbatim.
"In your area we do offer dual eligible special needs plans, these plans are specifically designed for anyone who has both Medicare and Medicaid. Would you like to hear more about this plan?"
What portion of the application does QA mention that our team misses the most?
Failure to read the required verbiage for payment methods.
*We can all refer to page 15 on the document TRN-REF-851a to get a refresher of the verbiage.