Faster Service with Claims Update

Physician practices now have a new tool in their arsenal to allow all claims to be submitted electronically — including corrected or canceled claims.

In the past, Humana’s system had to receive paper copies of corrected claims for commercial or Medicare members that were stamped “corrected.” Now, thanks to a system upgrade, providers’ offices can submit corrected claims electronically with a claim frequency code.

The claim frequency code, also known as the claim submission reason code or claims frequency indicator, is a required field on an electronic claim submission. In the past, many providers used a “1” in this field and moved on to complete the form. If corrected claims were submitted electronically rather than on paper, the claim risked being misidentified as a duplicate claim and was denied.

This code area is the equivalent of the third digit in a three-digit “type of bill” code field. To ensure proper handling of a corrected code, please use the following codes in the claim frequency field:

1 = original bill
7 = replacement of prior claim
8 = void/cancel of prior claim

Correctly coded claims will be sent immediately to the appropriate processing area, which will increase payment accuracy and speed.

“We’ve often seen incorrect duplicate denials on claims because we had no way of knowing a claim was corrected,” said Chris Jacobi, process consultant for government claims. “Our goals with this update are to decrease rework and give physicians an opportunity to bill these electronically instead of sending them stamped, which will save costs for physicians and Humana.”

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Safeguarding Humana Members

In 2007, Humana developed its member safety program. Today, that program is well under way, focusing on medication safety, labs and technology, severe preventable conditions (“never events”) and Agency for Healthcare Research & Quality (AHRQ) patient safety indicators.

Humana is making strides in monitoring and measuring member safety, particularly regarding medications and technology. Humana’s initiatives to help minimize the dangers medication and technology pose to members include:

• Tracking usage of selected Beers List medications in members 65 years old and older. The Beers List (available at www.dcri.duke.edu/ccge/curtis/beers.html) includes medications that can increase the risk of complications among senior patients.
  
  
• Observing trends among members who are prescribed drugs that frequently cause complications, including warfarin, insulin and opioids.
  
  
• Supporting technology safety. Humana uses RadConsult™
  and RadSite™ to facilitate inspection and proper utilization of equipment, as well as offer assistance on evidence-based guidance for ordering procedures.
  
  
• Following the increased prevalence of methicillin-resistant Staphylococcus aureus (MRSA) to trend the incidence among Humana members.
  

The Member Safety Committee will report periodically to the Quality Improvement Committee (QIC). The member safety Web site (www.humana.com/members/health/patient_safety.asp) will be regularly reviewed and updated to provide current, useful information.

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