Jeremy Stanly Job Aid and Refresher Humana. Introduction OHBP PCP Billing Letters VOB ID Cards...

Jeremy Stanly

Job Aid and Refresher

Humana

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• Introduction

• OHBP

• PCP

• Billing

• Letters

• VOB

• ID Cards

• General Updates

Agenda

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OHBP

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Primary Care Physician (PCP)


Billing/Demographics

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Letters

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VOB

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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

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 #.

ID Cards

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ID Cards

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• In the Status area “metered” means that the ID card has been requested and sent

• When metered the member should expect the ID card 7-14 business days from the sent date

• “In progress” means that the request is being processed

• “Pended” means that the card is waiting to be sent out

ID Cards

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ID Cards

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ID Cards

• 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***

http://dctm.humana.com/Mentor/xWeb/viewtopic.aspx?sChronicleID=0900092980d967bc&dl=0&searchID=VI-8d0df21ca9881e3&row=0

http://dctm.humana.com/Mentor/xWeb/viewtopic.aspx?sChronicleID=0900092980d967bc&dl=0&searchID=VI-8d0df21ca9881e3&row=0

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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.

CAS Vs. MTV Members

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• Most MTV or Metavance member ID’s start with 700

• Their billing is handled by HPS. HPS can be reached at 800-481-9758

CAS Vs. MTV Members

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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.

• The easiest way to make this determination is by going to the employer tab in CCP.

• The exchange type will tell you how it was purchased.

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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• Here is an example of an Off Marketplace Member



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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.

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.

HMO Premier


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Some members may have a dental benefit.

• To find if a member has one of these you would check on the Member tab of CCP.

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.

• 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

Dental


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If the member has questions about anything to do with pharmacy that includes:

• How much does my prescription cost?

• What is my pharmacy deductible?

• 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.

Pharmacy Transfers

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For questions regarding Pediatric Vision:

• Use the benefit grid the same way you learned how to quote the medical benefits.

Pediatric Vision


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Making a PCP Change on Humana.com


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I just wanted to reiterate here the process for making a PCP change:

• 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 #:

PCP Changes


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After filling out the above information, send your inquiry to:Service Center: Green BayDepartment: INDALLS CallsTeam: PCP UpdateUser: 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**

PCP Changes


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Ordering ID Cards on Humana.com

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• Scroll down on the home page to related links

• Click on the view medical ID Card

• 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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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

Humana.com

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Questions

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Jeremy Stanly Job Aid and Refresher Humana. Introduction OHBP PCP Billing Letters VOB ID Cards...

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