Serving and Supporting Providers

Humana is making real-time updates to our processes in response to COVID-19 so we can better serve and support our providers.

Claims Processing and Payments:

We have made changes to benefits and administrative requirements to streamline processes and increase access to care.

Suspension of Medicare sequestration

The Coronavirus Aid, Relief and Economic Security (CARES) Act, signed into law on March 27, includes provisions to temporarily suspend the Medicare sequester between May 1, 2020, and Dec. 31, 2020. During this time, Medicare plans will not have CMS premium and fee-for-service claim payments reduced, as they are currently. It is expected sequestration will return in 2021.

Utilization Management

Effective April 1, 2020: Suspension of most pre-authorization requirements and referrals

  • Previously, Humana suspended pre-authorization requirements on COVID-related diagnoses, excluding post-discharge, for both participating/in-network and non-participating/out-of-network providers
  • Humana is expanding this suspension to include suspending nearly all pre-authorization requirements for participating/in-network providers. This applies to inpatient (acute and post-acute), outpatient, and all referrals for Humana’s individual and Group Medicare Advantage, Commercial Group, and Medicaid plans
  • This continues to apply to both participating/in-network and non-participating /out-of-network providers when the member has a COVID-related diagnosis
  • Otherwise, non-par/out-of-network providers must continue to follow referral requirements and submit authorization requests per Humana’s policy
  • Drug/pharmacy related requests (Commercial, Part D and Part B), Transplant, and Genetics-related pre-authorization requirements will continue to be in effect

In the interest of our members’ health and to help support future transitions of care, please continue to submit a notification as normal when your Humana-covered patients are admitted to the hospital, even when authorization is not required. The notification will allow us to track patients’ progress through the healthcare delivery system and provide assistance in real time. You will receive automatic approval when you submit the notification.

Finally, Humana is extending previously approved authorizations to a 90-day approval timeframe, except for home health authorizations, which are being extended for 60 days.

Note: Per the May 15, 2020, letter, PDF opens new window from Humana’s chief medical and corporate affairs officer, Humana will lift the suspension of non-COVID-related diagnoses effective May 22, 2020.

Stars and Risk Adjustment:

We have received many questions from across our provider network related to Star and Risk Adjustment programs. We are communicating what we know now, and we will continue to work with the Centers for Medicare & Medicaid Services (CMS) and provide updates to you as we learn more.

CMS recently released guidance clarifying that telehealth services provided using an interactive audio and video telecommunications system that permits real-time interactive communication satisfy the face-to-face requirement for purposes of risk adjustment data eligibility. Refer to this FAQ, PDF opens new window on our COVID-19 telemedicine page for more details.

Changes to the Star Ratings Program that impact plan years 2021 and 2022 have also been communicated. In an effort to minimize COVID-19 exposure risks, CMS has granted flexibilities that enable health plans, healthcare providers and physician offices to focus on caring for our communities during this public health emergency. For more information, click here.

We will continue to re-evaluate our programs and processes as we further understand the severity and duration of the current pandemic.

Medicaid Providers

If you are a Humana Medicaid provider, please refer to the webpage for your particular state for the latest Medicaid-specific updates:

Florida Medicaid, click here.

Kentucky Medicaid, click here.

Illinois Medicaid, click here.

Call Centers:

Two call centers are at reduced capacity due to shelter in place requirements in specific geographies, and this may result in longer hold times than usual. We encourage providers to leverage self-service tools where possible through Availity.com.

Credentialing:

The Humana credentialing team is applying any federal or state emergency regulations for COVID-19 including such items as:

  • Waiving site visit requirements
  • Approving licensed providers to practice outside of their licensed state
  • Placing a hold on the decredentialing process (only for providers missing information)

These are temporary credentialing changes based on the emergency regulations. The normal procedures will apply when the emergency regulations are lifted.

If there are additional ways we can support you and your healthcare organization, please call our Provider Relations department at 1-866-427-7478 or contact your Humana representative.

Durable Medical Equipment Delivery (DME):

To support social distancing, DME vendors should waive the signature-at-delivery requirement for DME-delivered to members with a COVID-19-related diagnosis.