Onboarding
What is AEP and when does it occur?
Annual Enrollment Period cccurs between October 15th and December 7th
How can you view communication relayed to members?
RTI or EMME
Where would you locate a member's care coordinator/manager?
Guiding Care
How can you access mentor?
go-link go/mentor, myapps or quickstart
CRM stands for what?
Customer Relationship Management
What is HIPAA?
A federal law that protects the use and disclosure of an individuals protected health information
A provider must be credentialed under what specialties to be assigned as a PCP?
Family, General, Internal, Geriatric Medicine, or Obstetrics and Gynecology
What is PARE logic and what does it stand for?
Ancillary service providers that get reimbursed at the in-network rate even if they're out-of-network
Pathologist
Anesthesiologist
Radiologist
Emergency room physicians
What is the name of the mentor index used?
Integrated Medicare Medicaid Calls Document Index
What is the classification and intent for ordering a provider directory for a member?
Class=Fulfilment Intent=Letter/Form Request
What is Humana's required standardized greeting?
Thank you for calling Humana. My name is (First Name), your healthcare advocate. How can I help you today?
What is needed for a Minor MyHumana account to be activated in medicaid states?
Documentation - Letter of Authority and Copy of Official Document
What is the name of the tool used locate resources in members area that are not provided by the plan benefits?
Humana Community Navigator
What is the name of the mentor you follow for Michigan Self-Directed Services?
Humana Self-Directed Care for LTSS
What must you do in CRM before you can access a members account?
Create an interaction
What are the perfect member experience principles?
Know Me, Show Me You Care, Make it Easy, Help Me
True or False
Demographics can be updated/verified by someone with a Consent-PHI form on file
False
Only the member or POA Type C, H or O can
Where do you verify that a member qualifies for the Healthy Options Allowance benefit?
Debut
What mentor(s) would you use for a non-english speaking caller?
Incoming Foreign Language Calls, Foreign Language Call Overview, Interpretation Services Translation Assistance and Leader Escalation Procedures
When and how often are demographics verified?
90 days have elapsed since last update/verification
Call requires something to be mailed. emailed, or a return phone call placed
CRM Alert indicates information is needed
Caller reports an address change
What is the difference between original medicare and medicare advantage?
Original is offered by the federal government while medicare advantage is offered by private insurance companies
What does HEAR acronym stand for?
H-Hear
E-Empathize
A-Apologize
R-Resolve the issue
What are each state (IL, MI, SC) transportation vendor's name?
IL- Medicare/No Benefit Medicaid/MTM
MI- Medicare/SafeRide Health Medicaid/SafeRide or Triple A
SC-Medicare/No Benefit Medicaid/Carved out
What is the name of the mentor used to aid on the job for what can and cannot be disclosed with or without authentication?
HIPAA Job Aid Member or Individuals
Where do you check for open cases?
Cases/Tasks from the drop down/carrot