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.

Provider self-service resources

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

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.

Electronic claim and encounter submission clearinghouses

Providers may also submit Humana claims to these clearinghouses:

Clearinghouse Website Claims payer ID Encounters payer ID Phone
Availity www.availity.com 61101 61102 1-800-282-4548
ZirMed www.zirmed.com 61101 61102 1-877-494-7633
Gateway EDI www.gatewayedi.com 61101 61102 1-800-556-2231
McKesson www.mckesson.com 61101 61102 1-800-782-1334
Capario www.capario.com 61101 61102 1-800-792-5256
SSI Group www.thessigroup.com 61101 61102 1-800-881-2739
Inmediata (Puerto Rico only) www.inmediata.com 61101 61102 1-787-783-3233


Claims submission time frames

Health care providers are encouraged to note the following claims submission time frames for Medicare Advantage and commercial claims:

Plan


Claims Submission Time Frame


Medicare Advantage Claims must be submitted within one calendar year from the date of service.
Commercial Claims must be submitted within the time stipulated in the provider agreement or the applicable state law.
Generally, these claims must be submitted within:
  • 180 days from the date of service for physicians
  • 90 days from the date of service for facilities and ancillary providers


Valid NPI required on all submitted claims/encounters

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.

For more information, review these frequently asked questions or visit this CMS website.

Questions?

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 deployment@humana.com 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.