The document discusses the goals and strategies of a provider relations consulting organization. It aims to help providers achieve lifelong well-being by focusing on education, service, and support. Key points include reducing administrative burdens on providers through tools and resources, conducting personalized office visits to educate providers, and gathering feedback to improve services.

1. Provider
Relations
Consultants
What’s Important
To Us….

2. Our
Dream….
To help people
achieve lifelong
well-being

3. Support Roles
 Providers
 Sales
 Contracting
Top Priority:
Provider
Education

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

6. Perfect Service
Values
 Integrity  Accountability
 Respect  Quality
 Teamwork  Leadership &
 Transparency Innovation

7. Perfect Service
Characteristics
 Accurate  Proactive
 Reliable  Personalized
 Easy to Use
 Courteous

9. Proactive
 Anticipation
 Respond
 Guidance
 Creating
Opportunity

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

12. Office visit
strategy:
 Market grade
 Network strength
 Claim volume
 CMS
 Competition change
 Provider claim
issues-reeducation
 Sales opportunity,
suggestions

13. Office visit
strategy:
 Primary Care
Practitioners
 New Providers
 High Volume
Specialists:
• Cardiology
• Dermatology
• Gastroenterology
• Optometry
• Orthopedic
• Pulmonary
• Nephrology
• Rheumatology
• Urology

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

20. Humana
Guidance Center
Duncanville, TX

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

23. Zoomerang
Surveys
 Agenda
 Knowledge
 Questions
 Objections
 Functional
 Relevant
 Future Visits

24. Support Roles
 Providers
 Contracting
 Sales

25. Project MTC
Aversion
 Alternative urology
and rheumatology
providers listings
 Verify acceptance
status
 Cross referenced
across four
databases

26. Support Roles
 Providers
 Contracting
 Sales

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

32. One Dream,
Our
Commitment…
 Inspire,
 Create
 Engage
every day!

33. For All That
You Do….
THANK
YOU!