Automated Phone Systems Enhanced

Health care providers in the Humana network triggered several changes to Humana’s automated information lines that were implemented this summer.

“In an effort to simplify our internal processes to serve our providers better, Humana recently integrated our automated precertification interactive voice response (IVR) system with the Medical Automated Information Line (AIL),” said Mark Webb, interactive voice response process engineer for Humana. In short, providers can now access all of Humana’s telephonic self-service capabilities with just one phone call.

“We interviewed providers and tried to pinpoint the functionality that was lacking in the system,” said Webb. “The major changes in claims and eligibility were a direct result of those meetings.”

Providers who call the system can now enter their tax identification number and pull up patient service claims in two ways:

• Enter a date to get claims for all members seen and served on that date.
• Enter a date and member identification number to get the claim for a specific patient service rendered on that date.

The fax that providers receive with claims information has also improved. Now in a remit format, the fax includes the status of 40 claims per page.

“It used to take two pages per claim, but now we can get 40 claims on one page,” Webb said.

Provider requests also led to an improved coverage and benefits function. Providers can now retrieve specific eligibility information — basic copayments, deductibles or other details — without listening to all coverage information.

“The old system would play back lots of information about the patient — an information dump — when the provider may have only needed a specific detail in the middle. We broke it out so that providers do not have to listen to everything else,” Webb said.

Members who have plans that require precertifications to authorize payments can now do so through Humana’s standard customer service number found on the back of member ID cards. This feature will continue to be offered at Humana’s traditional toll-free precertification number, which is (800) 523-0023.

To access this feature using our customer service numbers (such as
1-800-4-HUMANA), select “Provider” from the opening greeting and then choose “Precertification.” Providers can select status retrieval or initiate a precertification. Humana’s traditional precertification lines have also changed to offer all other self-service functionality, such as eligibility, coverage and benefits, claims and referrals — as well as precertification initiation and status.

If you have questions or need more information, call Humana Customer
Service at (800) 448-6262.

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