Noncovered Services for Facilities Clarified
It has recently come to our attention that some charges for noncovered facility services (e.g., experimental and investigational, cosmetic, etc.) were incorrectly allowed for facilities. To remedy this inconsistency and follow Humana’s clinical and claims payment policies, effective January 25, 2013, Humana began denying all noncovered codes billed in the Type 2 field on facility claims. Noncovered services are listed under “Limitations and Exclusions” on the member’s Certificate/Evidence of Coverage.