A Humana Healthcare Provider caring for a Medicare patient.

Medicare Provider Materials

Humana offers Medicare Advantage (MA) plans for individual Medicare beneficiaries and for employer group Medicare benefits. The resources below give provider-specific information about the types of Medicare Advantage plans, including operational and reimbursement guidelines, provider qualifications and requirements, frequently asked questions, and other information about Humana health benefits for seniors.

The provider materials below are for the 2013 plan year followed by the documents for the 2012 plan year. The 2012 materials will be removed in February 2013.

2013 Humana MA Health Maintenance Organization (HMO) Plan

The following documents contain information on HMO, HMO-Point-of-Service (HMO-POS) and HMO SNP (special needs) plans.

HMO Electronic Claims Flier
(234 KB) Download PDF
English
HMO Frequently Asked Questions
(3.69 MB) Download PDF
English

2013 Humana MA Preferred Provider Organization (PPO) Plan

PPO Electronic Claims Flier
(236 KB) Download PDF
English
PPO Frequently Asked Questions
(2.55 MB) Download PDF
English

2013 Humana MA Non-network Private Fee-for-Service (PFFS) Plan

Non-network PFFS Electronic Claims Flier
(208 KB) Download PDF
English
Non-network PFFS Frequently Asked Questions
(4.33 MB) Download PDF
English
Non-network Reimbursement Methodology
(3.04 MB) Download PDF
English

2013 Humana MA Network PFFS Plan

Network PFFS Electronic Claims Flier
(193 KB) Download PDF
English
Network PFFS Frequently Asked Questions
(4.04 MB) Download PDF
English
Provider and Medicare Beneficiary Need to Know Flier
(134 KB) Download PDF
English

2012 Humana MA Health Maintenance Organization (HMO) Plan

The following documents contain information on both HMO and HMO-Point-of-Service (HMO-POS) plans

HMO Electronic Claims Flier
(164 KB) Download PDF
English
HMO Frequently Asked Questions
(2.58 MB) Download PDF
English

2012 Humana MA Preferred Provider Organization (PPO) Plan

The following documents contain information on both HMO and HMO-Point-of-Service (HMO-POS) plans

PPO Electronic Claims Flier
(147 KB) Download PDF
English
PPO Frequently Asked Questions
(2.57 MB) Download PDF
English

2012 Humana MA Non-network Private Fee-for-Service (PFFS) Plan

Non-network PFFS Electronic Claims Flier
(191 KB)
English
Non-network PFFS Frequently Asked Questions
(3.15 MB)
English
Non-network Reimbursement Methodology
(1.49 MB)
English
Humana 2013 PFFS Terms and Conditions of Payment
View Webpage

2012 Humana MA Network PFFS Plan

Network PFFS Electronic Claims Flier
(186 KB) Download PDF
English
Network PFFS Frequently Asked Questions
(4.32 MB) Download PDF
English
Provider and Medicare Beneficiary Need to Know Flier
(134 KB) Download PDF
English
Humana 2012 PFFS Terms and Conditions of Payment
View Webpage

Other Medicare Materials

Information in the following documents covers programs and services that support Humana Medicare-participating providers and members.

What is Medicare Risk Adjustment (MRA)?
(75 KB) Download PDF
English
SilverSneakers® Fitness Program
(1.58 MB) Download PDF
English
Provider Notice Regarding Influenza Pandemic Emergency
(20 KB) Download Document
English
Humana's Well Dine Food Program
View Webpage

Note: Humana publishes medical guidelines from a number of well-respected national sources. These guidelines may have some differences in recommendations. Information contained in the guidelines is not a substitute for a health care professional's clinical judgment and is not always applicable to an individual. Therefore, the health care professional and patient should work in partnership in the decision-making process regarding the patient's treatment. Furthermore, using this information will not guarantee a specific outcome for each patient. None of the information in the guidelines is intended to interfere with or prohibit clinical decisions made by a treating health care professional regarding medically available treatment options of patients. Since publication of these guidelines is not a promise of coverage, individuals should review their coverage to determine benefits.

Links to various other Websites from this site are provided for your convenience only and do not constitute or imply endorsement by Humana of these sites, any products or services described on these sites, or of any other material contained therein. Humana disclaims responsibility for their content and accuracy.