Tools and Resources for Physicians and Other Healthcare Providers

Learn about Humana’s inventory of useful tools and resources, which can simplify your claims-related and other interactions with Humana. Printable resource guides are included.

Updated: Jul 2025 Runtime: 9:18 View video presentation View tip sheet

Americans with Disabilities Act (ADA) Accommodation: Compliance for Providers

Learn about the Americans with Disabilities Act (ADA) and the importance of ADA compliance for healthcare providers. This information applies to providers with Humana Medicare Advantage and Medicaid contracts.

Released: Mar 2026 Runtime: 13:47 View video presentation View tip sheet

Americans with Disabilities Act (ADA) Accommodation: Responding to access or discrimination complaints

Learn about the Americans with Disabilities Act (ADA) and how Humana handles complaints and corrective action. This information applies to providers with Humana Medicare Advantage and Medicaid contracts.

Released: Mar 2026 Runtime: 10:11 View video presentation View tip sheet

Anatomical Modifiers

Learn about Humana’s policy requiring the use of anatomical modifiers when submitting claims for your patients with Humana Medicare Advantage and select Medicaid plans.

Updated: Feb 2026 Runtime: 13:09 View video presentation View tip sheet

Application of Medicare NCD/LCD Guidelines

Learn how Humana administers Medicare national coverage determinations (NCDs), local coverage determinations (LCDs) and related articles for Medicare Advantage plans.

Updated: Aug 2025 Runtime: 11:01 View video presentation View tip sheet

Authorizations - Avoid Claim Denials

Learn about the importance of obtaining an authorization or preauthorization, when required; about options for obtaining an authorization or preauthorization; and about the appropriate steps to take when an authorization- or preauthorization-related claim is denied. The information in this presentation applies to claims submitted for your patients with Humana Medicare Advantage (MA) plans.

Updated: Dec 2025 Runtime: 16:55 View video presentation View tip sheet

Availity Editing Services (AES)

Learn about the Availity Editing Services (AES) tool and its benefits for claim submission. This information applies to professional and facility claims submitted for your patients with Humana Medicare Advantage (MA) and select Medicaid plans.

Updated: Sep 2025 Runtime: 12:21 View video presentation View tip sheet

Availity Essentials Overpayments Tool

Learn about the Availity Essentials Overpayments tool, where to find the tool and the benefits of using the tool to manage overpayments identified by Humana. The information applies to claims submitted for your patients with Humana Medicare Advantage (MA) and Medicaid plans.

Updated: Jan 2026 Runtime: 7:20 View video presentation View tip sheet

Bilateral Services and Modifier 50

Learn about Humana’s policies for reporting bilateral services and the use of modifier 50 for services provided to Medicare Advantage and members.

Updated: Jan 2026 Runtime: 8:41 View video presentation View tip sheet

Chronic Care Management and Principal Care Management Services

Learn about Humana’s policy for coverage of chronic care management, complex chronic care management and principal care management services when submitting claims for your patients with Humana Medicare Advantage and Medicaid plans.

Updated: May 2026 Runtime: 13:27 View video presentation View tip sheet

Claim Disputes and Corrected Claims

Learn about Humana’s processes for medical claim disputes and corrected claims. This information pertains to professional and facility claims submitted for your patients with Humana Medicare Advantage plans.

Updated: Sep 2025 Runtime: 14:13 View video presentation View tip sheet

Claim Processing Edit Notifications

Learn about the claim processing edits page and how to access and use claim code-editing information located there as a resource for understanding how Humana processes claims. This presentation applies to claims submitted for services for your patients with Humana Medicare Advantage and Medicaid plans.

Updated: May 2025 Runtime: 6:57 View video presentation View tip sheet

Continuous Glucose Monitors (CGMs)

Learn about continuous glucose monitors (CGMs) and guidance around the coverage criteria and appropriate billing. The information in this presentation applies to claims submitted for your patients with Humana Medicare Advantage plans.

Updated: Jan 2026 Runtime: 10:21 View video presentation View tip sheet

Drug Testing and Codes

Learn about Humana’s policies on drug testing for patients with Humana Medicare Advantage and select Medicaid plans.

Updated: May 2025 Runtime: 13:57 View video presentation View tip sheet

Durable Medical Equipment - Guidance Highlights

Learn about Humana’s general guidance related to durable medical equipment, prosthetics, orthotics, and supplies, or DME. This presentation applies to claims submitted for services for your patients with Humana Medicare Advantage plans.

Updated: Aug 2025 Runtime: 7:51 View video presentation View tip sheet

Emergency Department E/M Reimbursement

Learn about Humana’s policy for reimbursing in-network facility claims for emergency department evaluation and management services rendered to patients with Humana Medicare Advantage plan.

Updated: Oct 2025 Runtime: 14:02 View video presentation View tip sheet

Florida Dual-Eligible and Crossover Claims

Learn about managing your claims for dual-eligible patients in Florida with both Medicare and Humana Healthy Horizons® plans. This information applies to claims submitted for your dual-eligible patients in Florida with Medicare (Original or Medicare Advantage) and Humana Healthy Horizons plans.

Updated: Feb 2026 Runtime: 7:53 View video presentation View tip sheet

Home Health Billing

Learn about Humana’s guidelines for submitting claims for home health services for your patients with Medicare Advantage plans.

Updated: Apr 2026 Runtime: 9:29 View video presentation View tip sheet

Humana's Approach to Code Editing

Learn about Humana’s approach to code editing for claims for your patients with Humana Medicare Advantage and Medicaid plans.

Updated: Feb 2026 Runtime: 9:34 View video presentation View tip sheet

Humana's Maximum Unit Values

Learn about Humana’s approach to maximum unit values for claims submitted for your patients with Humana Medicare Advantage and Medicaid plans.

Updated: Nov 2025 Runtime: 10:26 View video presentation View tip sheet

Medical Claim Appeals

Learn about Humana’s policy on medical claim appeals for your patients with Humana Medicare Advantage and Medicaid plans.

Updated: Sep 2025 Runtime: 13:56 View video presentation View tip sheet

Medical Record Management (MRM) Tool - Benefits of Online Submission

Learn about the importance of medical record reviews and the benefits of submitting requested medical records online. This information applies to claims submitted for your patients with Humana Medicare Advantage and Medicaid plans.

Updated: May 2025 Runtime: 9:27 View video presentation View tip sheet

Medicare Advantage Preventive Visits

Learn about Humana’s policies for preventive visits for your patients with Humana Medicare Advantage plans. Topics covered include the Initial Preventive Physical Examination (IPPE), Annual Wellness Visit, Annual Preventive Physical Exam and Well Woman Exam.

Updated: Jul 2025 Runtime: 16:53 View video presentation View tip sheet

Medicare Advantage Preventive Visits - FQHC

Learn about Humana’s policies for preventive visits rendered in federally qualified health centers (FQHCs) for your patients with Humana Medicare Advantage plans. Topics covered include the Initial Preventive Physical Examination (IPPE), Annual Wellness Visit, Annual Preventive Physical Exam and Well Woman Exam.

Updated: Jul 2025 Runtime: 19:22 View video presentation View tip sheet

Medicare Advantage Preventive Visits - RHC

Learn about Humana’s policies for preventive visits rendered in a rural health clinic (RHCs) for your patients with Humana Medicare Advantage plans. Topics covered include the Initial Preventive Physical Examination (IPPE), Annual Wellness Visit, Annual Preventive Physical Exam and Well Woman Exam.

Updated: Jul 2025 Runtime: 17:31 View video presentation View tip sheet

Modifier 24

Learn about Humana’s policy on the use of modifier 24 when submitting claims for your patients with Humana Medicare Advantage plans.

Updated: Jun 2026 Runtime: 9:24 View video presentation View tip sheet

Modifier 25

Learn about Humana’s policy on the use of modifier 25 when submitting claims for your patients with Humana Medicare Advantage and select Medicaid plans.

Updated: Jul 2025 Runtime: 10:29 View video presentation View tip sheet

Modifiers 59 and X{EPSU}

Learn about Humana’s policy on the use of Modifier 59 and the X{EPSU} modifiers. This information applies to claims submitted for your patients with Humana Medicare Advantage and Medicaid plans.

Updated: Jul 2025 Runtime: 11:44 View video presentation View tip sheet

Modifiers 76 and 77

Learn about Humana’s policy on the use of modifiers 76 and 77 to indicate that a service is a repeat procedure. This presentation applies to claims submitted for services for your patients with Humana Medicare Advantage and select Medicaid plans.

Updated: Apr 2026 Runtime: 8:20 View video presentation View tip sheet

Multiple Evaluation and Management (E/M) Services

Learn about Humana’s policy for reimbursement of multiple E/M services for physicians and other professional providers submitting claims for patients with Humana Medicare Advantage and select Medicaid plans.

Updated: Sep 2025 Runtime: 11:17 View video presentation View tip sheet

Notifying CMS of ESRD Status

Learn about Humana's guidance for reporting end-stage renal disease for your patients with Humana Medicare Advantage and Medicaid plans.

Updated: Apr 2026 Runtime: 8:50 View video presentation View tip sheet

Procedure-to-Procedure Code Editing

Learn about Humana’s code editing for incidental, mutually exclusive and unbundled code combinations. This information applies to claims for your patients with Humana Medicare Advantage or select Medicaid plans.

Updated: Nov 2025 Runtime: 12:35 View video presentation View tip sheet

Professional Component and Technical Component (PC/TC)

Learn about Humana’s policies for proper reporting and reimbursement of the professional and technical components of a service for your patients with Humana Medicare Advantage and select Medicaid plans.

Updated: Jan 2026 Runtime: 10:20 View video presentation View tip sheet

Provider Portal: Joining Humana's Network or Submitting a Change

This presentation will provide guidance about signing into the provider portal and the self-service steps required to join the Humana network or submit a change. This information applies to select Humana Medicaid plans.

Updated: Feb 2026 Runtime: 8:25 View video presentation

Referrals - Avoid Claim Denials

Learn about the importance of obtaining a referral for a service, medication or durable medical equipment (DME) item when required, and the options for obtaining those referrals. The information in this presentation applies to claims submitted for your patients with Humana Medicare Advantage plans.

Updated: Feb 2026 Runtime: 12:42 View video presentation View tip sheet

Referrals vs Authorizations

Learn about a referral and an authorization and the difference between them. This information applies to referrals and authorizations submitted for your patients with Humana Medicare Advantage (MA) plans.

Updated: Dec 2025 Runtime: 13:35 View video presentation View tip sheet

Reporting Diagnosis Codes in the Primary Position

Learn about reporting primary diagnosis codes and how to avoid some common errors when reporting those codes. This information applies to claims submitted for your patients with Humana Medicare Advantage and Medicaid plans.

Updated: Apr 2026 Runtime: 18:24 View video presentation View tip sheet

Understanding an Explanation of Remittance (EOR)

Understand your Humana EOR for patients with Humana Medicare Advantage and Medicaid plans.

Updated: Jan 2026 Runtime: 16:45 View video presentation View tip sheet

Use of Diagnosis Pointers

Learn about Humana’s approach to diagnosis pointers for claims submitted for your patients with Humana Medicare Advantage and Medicaid plans.

Updated: Feb 2026 Runtime: 7:26 View video presentation View tip sheet

Use of Non-Specific Procedure Codes

Learn about Humana’s requirements for submission of non-specific, or unlisted, CPT or HCPCS codes for your patients with Humana Medicare Advantage (MA) and select Medicaid plans.

Updated: Dec 2025 Runtime: 12:36 View video presentation View tip sheet

Using Humana Resources to Address Patient Concerns - Related to Medicare Advantage Preventive Services

Learn about Humana’s coverage of Medicare Advantage (MA) preventive screening services and Humana resources available to address patient concerns related to those preventive visits. This information applies to services rendered for your patients with Humana MA plans.

Updated: Jun 2025 Runtime: 14:28 View video presentation View tip sheet

Vea nuestros tutoriales​​

Recursos destacados​​

Infórmese​​

Conozca acerca de Availity​​

Vea nuestros tutoriales

Recursos destacados

Infórmese

Conozca acerca de Availity