Humanaone Job Aid and Refresher

Report
Job Aid and Refresher
Humana
Jeremy Stanly
Agenda
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Introduction
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OHBP
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PCP
•
Billing
•
Letters
•
VOB
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ID Cards
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General Updates
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OHBP
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Primary Care
Physician (PCP)
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Billing/Demographics
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Letters
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VOB
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ID Cards
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ID Cards
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•
To check ID card Status you will go to HSS
Click on ID Card Management
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ID Cards
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Click on Search in the upper left hand corner.
•
Enter in the member’s ID #, if they do not have an ID # you
can pull them up using their Social Security #.
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ID Cards
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ID Cards
•
In the Status area “metered” means that the ID card has
been requested and sent
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When metered the member should expect the ID card 7-14
business days from the sent date
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“In progress” means that the request is being processed
•
“Pended” means that the card is waiting to be sent out
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ID Cards
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ID Cards
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If the ID card has not been sent out we have created some steps for you to follow:
1.
If the member just made a PCP change, again advise them that ID cards are on the way in 10-14
business days.
2.
If they have not made a PCP change advise the member that they can go to Humana.com to print their
ID card.
3.
If prior to 1/20/14 transfer to HumanaOne.
4.
If 1/20/14 or after, then follow the mentor document attached to the invite titled “Order ID Cards in
CCP”
***Reminder if the member has changed their PCP, new ID cards are automatically generated. Also if ID
Cards have been ordered in the last 14 business days, a new request will terminate the original request***
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CAS Vs. MTV Members
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•
Members with HMO plans are found on the CAS platform. Their ID
numbers begin with H such as H57632370.
Their billing is handled thru Ebilling.
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CAS Vs. MTV Members
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Most MTV or Metavance member ID’s start with 700
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Their billing is handled by HPS. HPS can be reached at 800-4819758
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On Marketplace Vs. Off Marketplace
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When determining who makes demographic updates or which
area handles a member’s billing, it is important to be able to
determine if a member purchased their plan on or off the
marketplace.
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The easiest way to make this determination is by going to the
employer tab in CCP.
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The exchange type will tell you how it was purchased.
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On Marketplace Vs. Off Marketplace
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Here is an example of someone who purchased on the Federal
Marketplace
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On Marketplace Vs. Off Marketplace
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Here is an example of an Off Marketplace Member
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HMO Premier
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As a reminder members on the FL HMO Premier Network do not require a
PCP. Do not attempt to assign those, if you get an error in CCP do not send
these to the tank. The first place to check if it is HMO Premier is when the
benefit grid populates in mentor.
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HMO Premier
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If it does not appear in mentor or you do not have access to
mentor, the other place to locate this is on the legacy member
tab in CCP. It will say HMN.
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Dental
Some members may have a dental benefit.
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To find if a member has one of these you would check on the
Member tab of CCP.
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Dental
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This plan has a CB next to it, so that would be a transfer to the
Dental CompBenefits area at 855-204-4929.
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For Dental Plans that do not have a CB they are stand alone
plans that go to Humana Specialty Benefits, there transfer
number is 877-282-5654
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Pharmacy Transfers
If the member has questions about anything to do with pharmacy
that includes:
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How much does my prescription cost?
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What is my pharmacy deductible?
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Where is the nearest in network pharmacy?
We transfer these to (internal number) 877-832-4229 and make
sure to advise the member their direct number in the future is
800-558-4444.
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Pediatric Vision
For questions regarding Pediatric Vision:
•
Use the benefit grid the same way you learned how to quote the
medical benefits.
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Making a PCP Change on Humana.com
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Making a PCP Change on Humana.com
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Making a PCP Change on Humana.com
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Making a PCP Change on Humana.com
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Making a PCP Change on Humana.com
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Making a PCP Change on Humana.com
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Making a PCP Change on Humana.com
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Making a PCP Change on Humana.com
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PCP Changes
I just wanted to reiterate here the process for making a PCP
change:
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All PCP changes should be made in CCP.
•
If an error message is received in CCP please fill out the below
template:
 Physician’s Name:
 Physician’s Address:
 CAS #:
 Member’s Call Back Phone #:
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PCP Changes
After filling out the above information, send your inquiry to:
 Service Center: Green Bay
 Department: INDALLS Calls
 Team: PCP Update
 User: Blank
Please do not utilize this tank unless there is an error in CCP. A
reminder again Florida HMO Premier plans do not require PCPs.
** Please do not use this tank for creating normal business inquiries, this tank is only for PCP
updates**
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Ordering ID Cards on Humana.com
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Ordering ID Cards on Humana.com
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Ordering ID Cards on Humana.com
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Ordering ID Cards on Humana.com
•
Scroll down on the home page to related links
•
Click on the view medical ID Card
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The member can print their ID Card
***Reminder that if a member already has changed their PCP it
automatically orders new ID cards***
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Humana.com
In addition to ordering ID Cards and changing a PCP, Humana.com is a good
resource for members. If the situation comes up please educate the member
that on Humana.com they can review other information such as:
• Their Policy Certificate
• Claim Information
• Benefit Information
• Humana Vitality
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Questions
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