Humana Begins Standardizing Reducing complexity in the health care system is a priority at Humana. Simplification will not only help to eliminate waste in the system, but will improve the accuracy and timeliness of the payment process. That is why Humana has the goal of standardizing and simplifying its networks. Humana is streamlining the number of standard, commercial networks from 56 to eight major networks. Ultimately, the network structure will include eight networks that match Humana’s standard products, as follows:
The intent of each network is to offer national reciprocity, meaning members can see any provider within the network, regardless of geography. What does this mean for providers? The changes to the network naming system are just that; changes in name only. It does not change provider participation with Humana, or reimbursement. Humana hopes standardization will increase clarity and familiarity with its products and networks, and decrease confusion on the part of the physicians’ office staff. Humana’s current activity will be focused on renaming the HMO networks to HMO Premier or HMO Select. Over the coming months, providers will see ID cards (excluding custom cards) move to include either of the two network names. One of the cards for members who are participating in Humana’s Open Access HMO product is shown below. Those members participating in a gated product will continue to have wording on their cards regarding PCP authorization. Those members participating in the HMO Select network will have the same ID format with only the network name change on the top left corner of the card.
One additional reminder: These network changes apply to commercial medical members only; Medicare and other government networks are not affected by this effort. The restructuring plan will continue into early 2009. For any questions
regarding these networks, call provider relations at 1-800-626-2741
between 8 a.m. and
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