Humana Medicare Automated Member Approval Calls

 

The information in this article is only applicable to Humana authorizations.

Humana Medicare members will now be notified of their authorization approvals over the phone. Providers will be able to view the status of these notifications in the Cohere platform on the patient summary.


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Possible scenarios:

Scenario

Explanation

Member answers.

The member is directly notified of authorization approval. Determination will be viewable in the Final Determination call log.

Member does not answer.

A voicemail message will be left notifying the member of approval.

Member does not answer and we leave a voicemail. Member returns the call. 

If the member returns Cohere’s call, the status will be updated to reflect the member answering the call.

The member does not answer and we cannot leave a voicemail.

Cohere will attempt to reach out to the member a maximum of three times. If contact cannot be made, we will mail a notification letter to the member. 

*Please note: You may no longer see the mail icon or a 'letter' in the portal if a patient is successfully notified via an automated outbound call and your provider organization is opted into receiving e-notifications. If there is a need to print a document for your records, the ‘Service Summary’ should contain all relevant information. 

Additional details about the nature of the call can be found in the Final Determination call log. 

  • Call disposition: outreach outcome
  • Number of attempts: how many times we have tried to reach the member.

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