Humana Offers Medicare Special Needs Plan

Humana is pleased to offer its Medicare members with diabetes and/or osteoarthritis access to the Medicare Special Needs Plan.

The plans offer specialized benefits and disease management to address the members' conditions, including the following:

Osteoarthritis

• massage therapy (10 visits per year) and osteoarthritis drugs covered in the gap on the osteoarthritis plan

Diabetes

• diabetes drugs including insulin, in the gap, $0 copayment for diabetes monitoring supplies and unlimited routine podiatry visits on the diabetes plan

In order for a member to participate in this program, his or her provider must verify his or her condition by signing the "Verification of Chronic Condition" form. The form requires the physician or the physician's office to confirm the condition by checking the appropriate box (either osteoarthritis or diabetes) and provide a signature, date, title and phone number. The form must be returned to Humana for processing. The form is available on the provider area of Humana.com Provider Portal for your convenience. You can find it by going to the Provider area of Humana's Web site and clicking "Tools & Resources," "Provider Tools" and "Clinical & Healthcare Resources" in the "Download & Print" section.

Members can enroll in the program now, and membership will become effective on January 1, 2008. This program is not available in all markets.

Back to top

What's New with NPI

Humana is committed to helping providers use their National Provider Identifier (NPI) numbers, and to offer as much assistance as possible when doing so. There is information available on Humana's Web site, including:

• Frequently asked questions
• Quick reference guides to help identify which fields will change as a result of NPI
• Humana's Contingency Plan

Humana has elected to execute a contingency plan to allow continued acceptance of dual identifier strategy in order for covered entities to come into full NPI compliance not to exceed May 23, 2008.

Recommendations from Humana:

• Submit NPI on all 837 claim transactions. 837 is a standard Health Insurance Portability and Accountability Act (HIPAA) claim transaction, which includes professional, institutional and dental claims. If providers do not obtain and use their NPI by the mandate date of May 23, 2008, they could encounter delays when processing claims.
• Use taxonomy codes on claims (recommended)
• If testing is desired, send a small batch of NPI only submissions – and monitor, round trip for payment accuracy

Visit www.humana.com and click on "Providers" and then "NPI" under "Quick Links" to view more information, or call Humana customer service at 1-800-448-6262.

Back to top

Humana Implements New
Technology for Preauthorization, Referrals

Humana is implementing new technology for its preauthorization and referral systems that will result in some noticeable changes.

Confirmation numbers for both preauthorization and referrals will now be nine digits instead of how they have appeared in the past. Additionally, the rarely used "update" function of Humana.com will no longer be available.

In addition to Humana.com, you can continue to process preauthorization and referrals through the following:

• By telephone through Humana's Interactive Voice Response system at (800) 626-2698 for referrals or (800) 523-0023 for preauthorization.
• Through Availity.com (for Availity states)

The new technology should result in better service by combining two legacy systems into one system for improved efficiency.

Back to top