Overview of Humana.com Functionality
for Primary Access Administrators

Eligibility and Benefits

Member Eligibility

• Effective/term dates, copays, group number, PCP assignment, etc.
• View amounts paid toward member’s deductible, annual max, etc.
• View summary of benefit certificate

Multiple Member Eligibility

• Inquire on up to 25 members per search
• Save searches for future use
• Effective/term dates, copays, group number, PCP assignment, etc.
• View amounts paid toward member’s deductible, annual max, etc.
• View summary of benefit certificate

Referrals / Authorizations

Referral Inquiry

• Use for HMO outpatient services
• Search for previously submitted referrals
• Extend referrals as necessary

Drug Prior Authorization Requests

• Submit prior authorization for medications requiring review

Referral Submission

• Use for all HMO outpatient services
• Get immediate referral number for approved referrals

View Inpatient Auth /Notification

• Use for all HMO and PPO inpatient authorizations
• Search for previously submitted requests
• Print hospital inpatient admission report

View Outpatient Service Authorizations

• Use for all PPO outpatient authorization
• Search for previously submitted requests

Submit Inpatient Auth / Notification

• Use for HMO and PPO inpatient authorizations and notifications

Submit Outpatient Service Authorization

• Use for PPO outpatient authorizations

PCP Inquiry of Claims Missing Referrals

• View list of claims rejected due to “no referral on file”
• Use as a reference tool for patients needing retro-referrals

Claims Management and Submission

Member Claim Status

• Single inquiry
• View claim details on submitted claims
• View specific claim’s “remittance detail”

Multiple Claims Inquiry

• Search for up to 25 previously submitted claims
• View specific claim’s “remittance detail”

Remittance Inquiry

• View all claims on a specific remittance
• Search by check number, member ID/DOB, date range, etc.
• Download HIPAA compliant 835 remittance file

Introduction to Online Claims Submission

• View information about submitting your Humana claims online
• Generate a request for additional information

Submit Claims Online

• Submit Humana-only claims at no cost
• View date and time stamp on each submission
• Generate claim reports

Resources and Communications

Secure Messaging Center

• Receive e-mail from Humana
• Employees’ e-mail must be entered on registration

Service Fund Communication

• Register for membership/eligibility reports
• HMO only

Service Fund Reports

• View/download/print HMO reports
• Member eligibility reports
• Claims paid reports
• Formatted reports and electronic files

Administrative Manuals

• Humana’s most current administrative manuals
• Updated provider bulletins

Submit Directory Changes

• Submit your changes directly online

Fee Schedules

• View professional fee schedules
• Provider must enter contracted reimbursement percentage rate

Administration

Register New Users

• Grant access for each individual employee
• Physician’s office controls access

Maintain User Information

• View each employees’ demographic information
• Change employees’ demographic information

Manage User Status

• Terminate/pend employees’ access
• Re-activate employees’ access
• View all employees’ current status

Assign Web Access Rights

• Grant access to individual employees for specific business functions
• Assign functions by employees’ work duties

Setup a Physician

• Register individual physicians
• Grant access to physician specific content

Maintain Organization Information

• Review your office’s demographic information
• Update information online
• Does NOT affect directory information

View Overall Security Profile

• Review all employees’ security levels
• Read only

Monitor Security Changes

• Review all changes to employees’ access
• Read only

Print Security Forms

• Change/add/delete tax ID number
• Change primary controlling authority
• Change primary access administrator

Delegation Administration

Delegate Work To Another Organization

• Grant access to your contracted billing service
• Physician’s office controls billing service access

Change Work Delegated To Another Organization

• Ability to grant specific business functions
• Ability to grant specific functions to multiple services
• Ability to revoke access to specific functions

Stop Delegating To Another Organization

• Revoke all functions given to billing services
• Physician’s office controls billing service access