stethoscope

Únase a nuestra red y encuentre información de acreditación.

Ingrese a Availity Essentials™ para acceder a los beneficios de los pacientes, información de reclamaciones y más.

Encuentre herramientas y materiales para ayudarle a trabajar con nosotros.

Conozca más acerca de las investigaciones y tendencias que tienen un impacto en su consultorio.

Encuentre información de autoservicio y números de teléfono, y actualice los datos de su proveedor.

Ver todos los recursos para trabajar con nosotros

Revise las listas de autorizaciones previas para obtener orientación sobre los servicios, medicamentos y envíos.

Información sobre el envío de autorizaciones previas

Autorización previa de medicamentos administrados por profesionales

Herramienta de búsqueda de autorización previa

Información sobre autorizaciones previas

Encuentre pautas sobre apelaciones e información sobre las políticas de pago.

Conozca cómo enviar reclamaciones y encontrar orientación sobre la codificación.

Pautas para la codificación de reclamaciones

Encuentre políticas sobre procedimientos, dispositivos y medicamentos.

Ver todos los recursos de cobertura y reclamaciones

Revise las pautas y programas de salud para ayudar a sus pacientes y su consultorio.

Ver todos los recursos de atención de pacientes

Encuentre beneficios, herramientas y recursos dentales.

Encuentre herramientas y recursos de farmacia.

Autorización previa para medicamentos recetados por profesionales 

Encuentre recursos específicos de cada estado para Humana Healthy Horizons® (Medicaid).

compass

Vea planes, conozca acerca de Medicare y explore recursos para afiliados.

Busque proveedores médicos, de la vista, dentales y de farmacia en la red.

Los afiliados deben ingresar para administrar su plan.

Ahora es más fácil

Un médico repasa información con una paciente adulta mayor

Provider Portal: Joining Humana’s Network

Released: October 2024. This presentation will provide guidance about signing into the provider portal and the self-service steps required to join the Humana network. This information applies Humana Healthy Horizons® in Indiana plans. Runtime 8:42

View video presentation here

Referrals - Avoid Claim Denials


Updated: September 2024. 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 and commercial plans. This presentation includes a printable tip sheet. Runtime: 15:10

View video presentation here

Medicare Advantage Preventive Visits

Updated: July 2024. 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. This presentation includes a printable tip sheet. Runtime: 22:12

View video presentation here

Medicare Advantage Preventive Visits – FQHC


Updated: July 2024. 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. This presentation includes a printable tip sheet. Runtime: 24:42

View video presentation here

Medicare Advantage Preventive Visits – RHC    


Updated: July 2024. 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. This presentation includes a printable tip sheet. Runtime: 22:51

View video presentation here

Genetic Testing - Billing and Coding for Medical and Laboratory Providers

Updated: July 2024. Learn about Humana’s billing expectations for coverable medically necessary genetic testing and how Humana will adjudicate and reimburse claims for those services. This information applies to claims submitted for your patients with Humana Medicare Advantage, select commercial and select Medicaid plans. This presentation includes a printable tip sheet. Runtime: 26:18


View video presentation here


Humana’s Maximum Unit Values

Updated: July 2024. Learn about Humana’s approach to maximum unit values for claims submitted for your patients with Humana Medicare Advantage, commercial and Medicaid plans. This presentation includes a printable tip sheet. Runtime: 12:13

View video presentation here

Use of Diagnosis Pointers

Updated: July 2024. Learn about Humana’s approach to diagnosis pointers for claims submitted for your patients with Humana Medicare Advantage, commercial and Medicaid plans. This presentation includes a printable tip sheet. Runtime: 9:50

View video presentation here

Authorizations - Avoid Claim Denials

Updated: June 2024. 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 and commercial plans. This presentation includes a printable tip sheet. Runtime: 19:25

View video presentation here

Medical Record Requests for Specialized Laboratory Services

Updated: June 2024. Learn about Humana’s expectations and requirements for medical record requests for specialized laboratory services (genetic testing, urine drug testing, infectious agent molecular testing and cytogenetic/pathology services). This information applies to claims submitted for your patients with Humana Medicare Advantage (MA), commercial and select Medicaid plans. The presentation includes a printable tip sheet. Runtime: 16:32

View video presentation here

Understanding an Explanation of Remittance (EOR)

Updated: June 2024. Understand your Humana EOR for patients with Humana Medicare Advantage, commercial and Medicaid plans. This presentation includes a printable tip sheet. Runtime: 18:39

View video presentation here

Bilateral Services and Modifier 50

Updated: May 2024. Learn about Humana’s policies for reporting bilateral services and the use of modifier 50 for services provided to Medicare Advantage and commercial members. This presentation includes a printable tip sheet. Runtime: 10:27

View video presentation here

Mutually Exclusive Diagnosis Combinations: ICD-10 Excludes 1 Notes

Updated: May 2024. Learn about Humana’s process for services billed with mutually exclusive ICD-10 code combinations. This information applies to professional claims submitted for your patients with commercial, Humana Medicare Advantage (MA) and select Medicaid plans. The presentation includes a printable tip sheet. Runtime: 9:01

View video presentation here

Professional Component and Technical Component (PC/TC)

Updated: April 2024. 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, commercial and select Medicaid plans. This presentation includes a printable tip sheet. Runtime: 12:57

View video presentation here

Procedure-to-Procedure Code Editing

Updated: April 2024. 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, commercial or select Medicaid plans. This presentation includes a printable tip sheet. Runtime: 14:42

View video presentation here

Use of Non-Specific Procedure Codes

Updated: April 2024. Learn about Humana’s requirements for submission of non-specific, or unlisted, CPT or HCPCS codes for your patients with Humana Medicare Advantage, commercial and select Medicaid plans. This presentation includes a printable tip sheet. Runtime: 14:22

View video presentation here

Availity Editing Services (AES)

Updated: April 2024. 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 commercial, Humana Medicare Advantage (MA) and select Medicaid plans. The presentation includes a printable tip sheet. Runtime: 14:21

View video presentation here

Referrals vs Authorizations

Updated: April 2024. 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) and commercial plans. This presentation includes a printable tip sheet. Runtime: 15:22

View video presentation here

Medical Claim Appeals

Updated: April 2024. Learn about Humana’s policy on medical claim appeals for your patients with Humana Medicare Advantage, commercial and Medicaid plans. This presentation includes a printable tip sheet. Runtime: 18:58

View video presentation here

Claim Disputes and Corrected Claims

Updated: April 2024. 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 and commercial plans. This presentation includes a printable tip sheet. Runtime: 16:47

View video presentation here

Application of Medicare NCD/LCD Guidelines

Updated: March 2024. Learn how Humana administers Medicare national coverage determinations (NCDs), local coverage determinations (LCDs) and related articles for Medicare Advantage plans. This presentation includes a printable tip sheet. Runtime 14:00

View video presentation here

Multiple Evaluation and Management (E/M) Services

Updated: February 2024. 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, commercial and select Medicaid plans. This presentation includes a printable tip sheet. Runtime: 13:04

View video presentation here

Modifier 25

Updated: February 2024. Learn about Humana’s policy on the use of modifier 25 when submitting claims for your patients with Humana Medicare Advantage, commercial and select Medicaid plans. This presentation includes a printable tip sheet. Runtime: 12:30

View video presentation here

Modifiers 96 and 97 (Habilitative and Rehabilitative Services)

Updated: February 2024. Learn about Humana’s policy requiring the use of modifiers 96 and 97 (habilitative and rehabilitative services) when submitting professional and institutional claims for your patients covered by Humana commercial plans with essential health benefits. This presentation includes a printable tip sheet. Runtime: 15:51

View video presentation here

Modifier 24

Updated: February 2024. Learn about Humana’s policy on the use of modifier 24 when submitting claims for your patients with Humana Medicare Advantage and commercial plans. This presentation includes a printable tip sheet. Runtime: 11:28

View video presentation here

Durable Medical Equipment – Guidance Highlights

Updated: February 2024. 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 and commercial plans. This presentation includes a printable tip sheet. Runtime: 9:47

View video presentation here

Claim Processing Edit Notifications

Updated: February 2024. 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 commercial plans. This presentation includes a printable tip sheet. Runtime: 8:35

View video presentation here

Modifiers 59 and X{EPSU}

Updated: January 2024. 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, commercial and Medicaid plans. This presentation includes a printable tip sheet. Runtime: 13:58

View video presentation here

Modifiers 76 and 77

Updated: January 2024. 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, commercial and select Medicaid plans. This presentation includes a printable tip sheet. Runtime: 10:06

View video presentation here

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

Updated: January 2024. Learn about the importance of medical record reviews and the benefits of submitting requested medical records online. The information applies to claims submitted for your patients with Humana Medicare Advantage, commercial and Medicaid plans. This presentation includes a printable tip sheet. Runtime: 10:53

View video presentation here

Home Health Billing

Updated: December 2023. Learn about Humana’s guidelines for submitting claims for home health services for your patients with Medicare Advantage and commercial plans. This presentation includes a printable tip sheet. Runtime 12:54

View video presentation here

Chronic Care Management and Principal Care Management Services

Updated: December 2023. 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. This presentation includes a printable tip sheet. Runtime: 15:26

View video presentation here

Drug Testing and Codes

Updated: December 2023. Learn about Humana’s policies on drug testing for patients with Humana Medicare Advantage, commercial and select Medicaid plans. This is an updated version of a previous presentation. This presentation includes a printable tip sheet. Runtime: 15:59

View video presentation here

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

Updated: December 2023. 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. This presentation includes a printable tip sheet. Runtime: 13:57

View video presentation here

Notifying CMS of ESRD Status

Updated: December 2023. Learn about Humana's guidance for reporting end-stage renal disease for your patients with Humana Medicare Advantage, commercial and Medicaid plans.This presentation includes a printable tip sheet. Runtime: 10:44

View video presentation here

Anatomical Modifiers

Updated: November 2023. Learn about Humana’s policy requiring the use of anatomical modifiers when submitting claims for your patients with Humana Medicare Advantage, commercial and select Medicaid plans. This presentation includes a printable tip sheet. Runtime: 15:09

View video presentation here

Reporting Diagnosis Codes in the Primary Position

Updated: October 2023. 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, commercial and Medicaid plans. This presentation includes a printable tip sheet. Runtime: 21:05

View video presentation here

Billing Hospice Services for VBID Demonstration Plans (2024)

Updated: October 2023. Learn about Humana’s requirements for submitting claims for hospice services provided as part of a value-based insurance design (VBID) demonstration plan. This information applies to claims submitted for your patients with Humana Medicare Advantage in Colorado, Florida, Georgia, Kentucky, Ohio, Virginia and Wisconsin. This presentation includes a printable tip sheet. Runtime: 17:03

View video presentation here

Humana’s Approach to Code Editing

Updated: October 2023. Learn about Humana’s approach to code editing for claims for your patients with Humana Medicare Advantage, commercial and Medicaid plans. This presentation includes a printable overview. Runtime: 12:18

View video presentation here

Continuous Glucose Monitors (CGMs)

Released: September 2023. 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. This presentation includes a printable tip sheet. Runtime: 12:42

View video presentation here

Emergency Department E/M Reimbursement

Updated: October 2023.Learn about Humana’s policy for reimbursing in-network facility claims for evaluation and management services rendered to patients with Humana Medicare Advantage plans, and for reimbursing claims submitted by all facilities, in-network and out-of-network, for patients with commercial plans. This presentation includes a printable tip sheet. Runtime: 16:20

View video presentation here

Florida Dual-Eligible and Crossover Claims

Updated: October 2023. 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. This presentation includes a printable tip sheet. Runtime 9:43

View video presentation here





Disclaimer: The information in these presentations is general and does not represent individual member benefits, coverage or payment determinations made by Humana; nor does it supersede any determination made by Humana. It does not guarantee claim payment and should not be used as legal advice or a legal opinion. As claims policies and guidelines change, the information in these presentations may be updated to reflect those changes. For Humana member claim or benefit information, please call the number on the back of the member’s ID card.

copy

Primer plano de un estetoscopio sobre una pila de cuadernos

Políticas de cobertura médica y de farmacia

Temas

Manténgase conectado

¿Cómo podemos mejorar la serie Making It Easier?

Vea más recursos de capacitación

Enlaces relacionados

Enlaces relacionados