LEP
What is an LEP
Premium penalty for not having Part D coverage for 63 days or more
where can we go to send letters to a member?
EMME
when do we verify Demographics?
every 90 days
True or false
A representative can a activate a member's web account for them
False a represenative can only walk a member through the steps of setting it up
What is a grievance?
When the member expresses dissatisfaction about something other than the way that a claim or a medical or pharmacy authorization processed
How long does an LEP last
For as long as the member has a prescription drug plan, or until they qualify for low income subsidy
Where can you go to find a smartsummary the member is asking about?
CRM and EMME
if a member calls from North Carolina and is moving to Washington state on the 20 of the month, when will their plan term?
on the last day of the month.
What system do we use to change the web password for a member?
Dam system ( Digital access manager)
What are the 3 ways a member can file a grievance?
Verbally, online at Humana.com, or on MyHumana.com
True or False
If a member disagrees with an LEP we advise them to call Medicare.
False
Where would you click to change the member's communications Preferences?
Member preferences link on the person Account page
who can report a demographic change?
Member/Power of Attorney/Executor of Estate/Agent
what is the ID card center used for if you are an advocate?
Guide members to view and/or print an electronic copy of their card themselves.
How long does a member have to file a grievance?
60 days
How long does a member have to submit creditable coverage information after the 1st letter is sent?
Members are encouraged to submit creditable coverage within 30 days. However, per a CMS grace period, they have a total of 90 days from the initial request to submit a creditable attestation.
What is the classificatin and intent for a call about a SmartSummary?
Classification: Communication
Intent: Smart Summary
What is the Classification and intent for Demographic changes?
what could we advise if the member's computer is not responding when they click the links?
Advise caller they may need to enable cookies functionality
Where do you route a Quality of care grievance?
CRM automatically routes to the Resolutions Team
What screen in CI will we find LEp information?
PCCV
What is the EMME letter code for the Consent for Release PHI Letter?
ME2427
What are the 5 demographic changes that we must hear from CMS to change?
Date of death / Date of birth / Medicare ID / Name / Gender
Where can you find the Web emulation link?
CRM policy member page if there is an activated MyHumana account or HSS Billing and Enrollment section
True or false
Only the member and certain types of POA have the authority to file a valid grievance
True