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Provider Tools
Clinical Tools- Quickly locate details about Humana's clinical practice guidelines, patient health education, clinical services and innovation, transplant services and disease management programs.
Education on Demand ─ Access this tool to view PowerPoint presentations with audio on topics such as RadConsult Online, the HumanaAccesssm Card and SmartSummary Rxsm. These educational presentations are available for viewing at your convenience.
Continuing Medical Education (CME) Opportunities - Find online opportunities to learn the latest information and recommendations regarding health care best practices.
Interactive Voice Response (IVR) - Save time by using our secure automated information lines to get information about precertifications, claims, referrals and more.
Humana Remittance Advice Code Descriptions - The attached document provides a comprehensive list of Humana's Remittance Advice Codes and Descriptions.
Provider Medicare Information – Obtain more information about plans offered in your area.
Paymentech - Humana is pleased to introduce a new program created exclusively for Humana and Humana ChoiceCare Network participating providers that is designed to help reduce credit card transaction fee costs for your practice. Through this new program, created by a Humana and Chase Paymentech Solutions, LLC partnership, your practice can accept credit cards at significantly discounted processing rates.
Preauthorization and Notification List - 2007 - The attached document provides a comprehensive list of services requiring preauthorization.
Preauthorization and Notification List - 2006 - The attached document provides a comprehensive list of services requiring preauthorization.
Provider Appeal Process - The attached document provides an explanation of the appeals process for medical doctors and doctors of Osteopathy.
Provider billing Dispute Process - The attached document provides an explanation and forms for appealing an adverse decision, including when and how to submit a dispute.
Prescription Tools and Resources - Learn more about Humana's pharmacy programs by using the drug list search, prescription tools and resources, generic drugs, locate a pharmacy and online pharmacy (ePocrates).
Credentialing Services - Council for Affordable Quality Healthcare (CAQH) – Click here to link to CAQH’s Universal Credentialing DataSource. Consolidate your efforts by using this single source for many of the credentialing needs of the health plans in which you participate.
Publications - Review our publications to learn about provider tools and services.
Resources for your Humana-insured patients - Learn more about services that can benefit your patients with Humana plans.
SmartSummary - The SmartSummary statement is the industry’s first comprehensive and personal, consumer-focused health benefits budgeting, planning and reporting document. Humana members receive their SmartSummary statement quarterly. Click here to view a sample of what they receive.
SmartSummary Rx - In a slightly different format and delivered on a monthly basis, SmartSummary Rx offers many of the same benefits of the SmartSummary statement to Humana's Medicare members. Click here for more details about SmartSummary Rx or here for a sample of the statement.
State/Market Specific Information - State/Market specific information
National Provider Identifier (NPI) - The Health Insurance Portability and Accountability Act (HIPAA) of 1996 mandated that all providers use a standard unique identifier on all HIPAA electronic transactions. As a result, use of your National Provider Identifier (NPI) is mandated on all HIPAA electronic transactions on or before May 23, 2007.
Humana’s dual identifier period is currently under way. During this time, we encourage you to continue to submit claims using the identifiers you have used in the past on any electronic transactions in addition to submitting your NPI. The dual identifier period ends on May 23, 2007.
You may also submit your NPI on forms found on Humana.com.
For more information about NPI, or other HIPAA standards,
please visit http://www.cms.hhs.gov/hipaa/hipaa2
NPI Frequently Asked Questions (FAQs)
Claims Processing Policies and Procedures – Obtain information about Humana’s code editing logic.
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