1 / 2

Agent Statement for Enrollment Correction

Issued: 2013. Agent Statement for Enrollment Correction .

kara
Download Presentation

Agent Statement for Enrollment Correction

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Issued: 2013 Agent Statement for Enrollment Correction An agent statement is needed when there is an enrollment discrepancy and the member /client or the agent has called Humana to correct the enrollment. To facilitate the enrollment correction, a written statement describing the discrepancy is needed from the agent in order to transmit the enrollment to CMS or if a retro submission is needed. The scenarios below will help agents in determining when a statement is needed to correct their client’s enrollment: Conflicting Plan Information Use this grid when there are conflicting or no information regarding Contract/PBP or Group/BSN on the members’ application Invalid Information Provided Use this grid when the information provided at the time of enrollment is invalid for processing • If multiple errors are involved, an agent statement is needed to correct the enrollment • Example: • Contract and PBP are provided and match the bubble information but Group and BSN do not match (will not require a letter) but incorrect effective date was used on the application (statement will be needed) Confidential – For Internal Usage Only

  2. Issued: 2013 Agent Statement for Enrollment Correction An agent statement is needed when there is an enrollment discrepancy and the member /client or the agent has called Humana to correct the enrollment. To facilitate the enrollment correction, a written statement is needed from the agent in order to transmit the enrollment to CMS or if a retro submission is needed. The scenarios below will help agents in determining when a statement is needed to correct their client’s enrollment: Wrongful Enrollment Due to Plan Confusion Use this grid when member complains that their premium, RX, etc. is not what was expected at the time of enrollment Unconfirmed Eligibility Use this grid when the eligibility confirmation for SNP plans were not received at the time of enrollment Late Submission Use this grid when application was not sent in timely Confidential – For Internal Usage Only

More Related