Digital Onboarding Expanded in 2017
The goal of Humana’s digital onboarding initiative is to create a simple, personal onboarding experience for new members within MyHumana. Members have a choice to receive important member communications either digitally or by standard mail. If the consumer chooses digital delivery, they will still receive their ID cards via standard mail. They will receive an email within 5 days of enrollment that will provide a link to register for MyHumana and take them to through the guided welcome experience.
What does this mean to customers?
They’ll start by completing their health assessment online and avoid waiting for a phone call. The customer won’t be buried in paper, yet they’ll have fast and easy access to plan documents. The member will still receive their ID card within 10 days of enrollment.
What does this mean to agents?
Agents need to understand the new member digital onboarding experience to be able to explain it to Humana members. The health risk assessment and other post-enrollment documents are now available digitally.
Learn more!
For more information, agents can refer to the job aid “Digital Onboarding” found on MarketPoint University. To access it, simply log into Humana MarketPoint University and search the term “Digital.”
2017 Star Rating
“Stars” is a Center for Medicare and Medicaid Services (CMS) program to improve quality for Medicare Advantage members. The program measures how well plans perform on over 50 measures. More detailed information on a plan’s Star rating may be found at www.medicare.gov.
AEP Stars Guidance
Humana wants to remind you that when presenting Star Ratings information to beneficiaries, agents must clearly present the overall rating of the plan. Agents may not use a Star Rating in an individual underlying category to imply a higher overall Star Rating. For example, if a Humana plan has received an overall rating of 3-stars, but received a 5-star rating in the category of customer service, the agent may not promote it as a “5-star plan.”
Agents may only reference a plan’s individual measures in conjunction with its overall rating. For example, if an individual measure of customer service is mentioned, the plan’s overall (summary) rating must be clearly presented with equal or greater emphasis. In addition, agents should not engage in any negative talk about CMS or the Star Rating system, especially in cases where a plan may have received a lower Star Rating than the previous year.
2017 Star Ratings Updates
The plan rating in all enrollment books should be replaced with the new plan rating by no later than 10/26. The plan rating documents will NOT automatically ship, so agents will need to order them through https://printandfulfillment.adp.com/HumanaDelegatedAgents/Reorder.aspx under the individual items section. Agents can also find links to the documents on Vantage in the Medicare Document Library under the tab 2017 PRDs. Both English and Spanish are available. The below screen shot provides instructions on how to access the Star Ratings documents.
Provider Participation Best Practices
Each year, a leading contributor to Section A complaints is provider participation. There are many drivers of these complaints – most of which are controllable by the agent. Over the past two months, Humana has conducted a deep-dive review of provider based Section A allegations. For those complaints where the agent was found to have made an error, they found a trend in the types of mistakes made by agents. The most important guidance Humana can give is that agents should ALWAYS use Physician Finder whenever possible as it is the most up-to-date and comprehensive list of participating providers for Humana/CarePlus.
Humana found that, of the cases reviewed, 50% of the provider-based Section A complaints were the result of the incorrect use of the Physician Finder tool. Please take some time and review the “Provider Selection” online training module located on MarketPoint University. This training covers all of the common errors our in-depth review found agents to make when using the Physician Finder tool.
Lastly, it is important that an agent confirms that a particular provider is in-network. Just because a provider was in-network last year, or a provider is affiliated with a particular hospital/group that is in-network, agents must not make the assumption that the provider will automatically be in-network as well. It is the agent’s duty to ensure the information they are explaining to the beneficiary is up-to-date and correct. It is the responsibility of agents who are marketing Humana/CarePlus to make sure you are giving clear, concise guidance and giving full disclosure when discussing provider participation.
What does this mean to agents?
Below Humana has identified some best practices that can help agents reduce the chances of complaints regarding provider participation.
During the appointment
When agents begin talking about provider participation during the sales presentation, here are some important reminders:
No matter which product is selected, agents should AVOID:
Calling the doctor’s office to find out if they accept Humana/CarePlus. Providers may ‘accept’ Humana without being in network. Always verify participation status with a verifiable source, such as Physician Finder.
Assuming that because a doctor is in-network for the HMO, they also accept the PPO.
Assuming that because a group/hospital that a doctor is associated with is in-network, then the doctor will automatically be in-network.
Assuming that a doctor is in-network because they were in-network last year.
Submitting an application with an invalid or blank primary care physician (PCP).
It is critical that you never suggest that a provider is or may be joining Humana/CarePlus’s network in the future.
Here are some BEST known methods to use when verifying provider participation:
Always use Physician Finder if you have Internet access.
Print a radius directory from Physician Finder before heading out to your appointment to have ready during the sales presentation.
Explain in detail how the provider network operates, including how the member will access care, especially as it relates to referral requirements and in-network vs. out-of-network coverage.
Demonstrate to prospects/members how to use Physician Finder so they are empowered to find their own doctors and specialists. Ask follow up questions to ensure the member has a clear understanding of how to find and access in-network doctors and hospitals.
After enrollment
Humana’s fulfillment center sends a provider directory to Humana enrollees no later than 10 days from receipt of CMS confirmation of enrollment, or by the last day of the first month of enrollment, whichever occurs first. As a reminder, CarePlus does not send a provider directory upon enrollment so agents must give one at the time of sale.
If your client contacts you about wanting to change their PCP, it is important that you inform them of the following:
Use the customer service telephone number located on the back of their member ID card to request a PCP change.
The change goes into effect the first day of the following month.
Recommend that he/she schedule an appointment with the new PCP in order to obtain the necessary referrals and prescriptions (as applicable) so as not to experience a lapse in care.
Medicare Sales Presentation Link on Vantage
Agents can now access the 2017 Medicare Sales Presentation Videos in the Sales and Marketing card in Vantage.
If agents still need to access the 2016 presentations, please instruct them to use the below links or they can access them by changing the URL link on the presentation page from 2017 to 2016.
2016 Medicare Sales Presentation Videos: https://media.humana.com/medicare2016
2017 Medicare Sales Presentation Videos: https://media.humana.com/medicare2017
To change the URL on the webpage, please see screenshots below:
Please contact your Account Manager with any questions!