Electronic claims submission
Submitting claims electronically may allow providers to decrease administrative costs and improve cash flow. Humana offers several electronic delivery options to connect providers.
Registered users of Humana.com have access to a no-cost solution for electronic claims submissions through Humana's relationship with ZirMed®. After logging into Humana.com, go to "Claim Tools," then choose "Submit Claims and Encounters" to access the ZirMed "Claim Management Center."
Availity®, LLC is Humana's central gateway for electronic data interchange (EDI) transactions. Humana providers can also use Availity as a no-cost solution for sending claims electronically. Visit Availity.com to get more information about direct claim submission.
Providers may also submit Humana claims to these clearinghouses:
|Clearinghouse||Website||Claims payer ID||Encounters payer ID||Phone|
|Inmediata (Puerto Rico only)||www.inmediata.com||61101||61102||1-787-783-3233|
Health care providers are encouraged to note the following claims submission time frames for Medicare Advantage and commercial claims:
Claims Submission Time Frame
|Medicare Advantage||Claims must be submitted within one calendar year from the date of service.|
Claims must be submitted within the time stipulated in the provider agreement or
the applicable state law.
Generally, these claims must be submitted within:
To satisfy a requirement from the Centers for Medicare & Medicaid Services (CMS), Humana must receive provider claims/encounters data with a valid National Provider Identifier (NPI). Claims/encounters submitted without the NPI will be rejected and returned to the submitting provider.
Do you have questions about submitting claims electronically or about claims you have already submitted?
If your claim rejects at the vendor level, please contact your vendor for assistance.
If you need assistance to submit claims electronically, please contact the Humana e-business team at firstname.lastname@example.org or call your vendor's customer service help line.
If you have questions regarding the status of a claim submitted electronically, log in and access the "Claims Search" tool available for registered users.