Real Time Claims Adjudication (RTCA)
— Frequently Asked Questions

1. Question: Will I also get my Humana payment in real time?
Answer: No, RTCA affords you the ability to collect patient responsibility at the point of service; however, Humana reimbursements will be received on your normal cycle times.

2. Question: My practice management system cannot submit in real time, but my office wants to. Is there any other option to enable me to take advantage of RTCA?
Answer: Yes, Humana has worked with ZirMed Inc. to develop a solution that provides the real-time claims adjudication capability without any required integration with your practice management system. This solution is adaptable to most practice management systems.

3. Question: Will I also need to submit these "real time" claims along with my normal batch process?
Answer: No, once the claim has been submitted in "real time" and an accepted claim response from Humana has been received, your transaction is complete. There is no need to submit the claim again.

4. Question: Must I be a contracted physician to submit real time claims?
Answer: No, Any health care provider rendering services to members enrolled in a Humana plan with an associated HumanaAccess card is eligible.

5. Question: Do I have to have an electronic medical record system (EMR) to submit real time claims?
Answer: No, An electronic medical record system (EMR) is not required for RTCA. However, some EMR systems have automated claims coding and/or charge-entry capability, which mitigates claim data entry at patient "checkout." This capability is an enhancement to the RTCA process.

6. Question: My vendor already submits claims to you "real time." What's the difference?
Answer: Claims transmitted for real-time claims adjudication require a specific connection with Availity, Humana’s central electronic data interchange (EDI) gateway, or one of its identified partners. This connection allows Humana and Availity to identify these claims for real-time processing. This connection does not exist with most clearinghouses.

7. Question: How soon after I transmit my claim will I know if my claim has been accepted?
Answer: Within a minute, you will receive a response from Humana letting you know the status of your claim submission.

8. Question: Can I submit all of my Humana claims through the RTCA connection?
Answer: No. Only claims administered on some of Humana’s plans will adjudicate in "real-time." All others will process through the regular EDI batch process. (For an explanation on how to identify Humana members whose claims can be adjudicated in real time, see the next question).

9. Question: How can I identify Humana members who can have their claims adjudicated in real time?
Answer: Members who can have their claims adjudicated in real time have been assigned unique member identifiers (UMIDs) that consist of nine digits followed by a two-digit suffix. The UMID for these members usually begins with zeros. (Example: 000123456-01). The member's UMID is displayed on the member's Humana ID card.

10. Question: Who can I contact to learn more about real-time claims adjudication?
Answer: Please contact deployment@humana.com, all e-mails will be responded to within 48 hours. You can also contact your Humana connectivity consultant directly.