4. Robert Wood Johnson Foundation
Study-June 2008
Surveyed time
providers spent
interacting with
health plans:
Authorizations
Referrals
Formularies
Claims
Credentialing
Contracting
Quality Data.
5. Robert Wood Johnson
Foundation Study –June 2008
45 Physician: 4.5
40 hours per week
35 Nurses: 19 hours
30 per week
25 Doctor Clerical: 36 hours
20 Nurse per week
15 Clerical Cost: $68,274 per
10 physician annually
5 Cost: U.S. $23-31
0 billion annually
Day Year
10. Personalized
Communication
methods
Tailored to
preferences and
interests
Relationships =
Trust
11. We Make Office
Calls
Empowering the Education in familiar,
“Insiders” comfortable setting
Knowledge specialists Personalized
Face of Humana communication
Year long, timely efforts
education Trend Awareness
Guidance
14. Current
Educational
Efforts
Review Provider
Resource Guide
Humana’s E
Capabilities
Value Added
Services
Authorization,
referral procedures
HEDIS/CAPHS
Marketing Partners/
Humana Boosters
15. Provider
Resource Guide
Tailored for specific
provider
Timely information
Physician/Medication
Quick Reference
Guides
Authorization/Referral
listing
Product Plan
information
Pharmacy information
16. Humana’s E-
Capabilities
Availity.com
Humana.com
Authorization/Referrals
Real time claim
adjudication
Saves time and money
Error proof
Contact information
17. Humana’s E-
Capabilities
NY Times Recognizes
Humana as Leader in
Real-Time Claims
Adjudication
Athena Health Payerview
SM rankings names
Humana Top Payer For
Second Consecutive Year
Humana only national
insurer to finish on top in
back-to-back years
18. Value Added
Services
Silver Sneakers
Active Outlook
Seminars
Guidance
Centers
Webinars
(providers)
19. Humana
Guidance
Center
Dallas, TX
Humana community
presence
Wide variety of
programs
21. Marketing
Partners
Office managers agree to
hand out and display our
“Medicare Decisions Made
Easy” brochure
List shared with sales
managers
“Humana Boosters”;
Providers who refer
patients to Humana
22. Personalized
Communication
Methods
March 22, 2010
Dear David;
I enjoyed our visit on Wednesday and
appreciated the time you set aside to speak
with me. I hope that the information
presented was of value to you and your office
Phone calls staff.. It is nice to see so many new faces in
Tyler and offer my best wishes for a
Emails rewarding career experience. Welcome
Home!
Fax As your provider affairs representative for
Zoomerang our senior products, I strive to give guidance
year round to assist you in administering our
Surveys measure member's Medicare Advantage plan. Please
feel free to contact me if you have any
our effectiveness questions or suggestions.
Thank you;
Sean M. Denoyer
Provider Affairs Consultant
Senior Products-North East Texas
27. Member Claim
Issues
Contact Customer
Service or MSOP
MSOPSupport@Humana.com
PSR’s only handle acute
provider claim issues
“Escalate” provider
claims issues after a
documented call to
customer service/MSOP
is made
28. Checking
Directory…
Call Humana Customer Verify location
Service Contact Us
Use Online Directory Send discrepancies via
Contact Provider’s office email
or business manager Physician's First and
Specify Humana Last Name, Group,
“Medicare Advantage” Phone Number,
product Specialty
29. Provider
Nominations
One step: email
nomination to Jennifer
Johnson
jjohnson46@humana.com
Do not nominate online
or through Choice Care
fax
Nominations do not
guarantee contracts
30. Your Provider
Nomination:
Physician’s Full Name
Specialty
Service and Billing
addresses
Phone Number
Name of product
requested
Tax ID Number
Good to have, but not
required: OM’s Name
contact info. Email
address, justification One
step: email nomination to
Jennifer Johnson
jjohnson46@humana.com
31. N.E. Texas
Special
Projects
Doctor’s Appreciation
Day Carnations
Recognition lunches for
High Volume, Boosters
and Generic providers
Office In-Services