Electronic claims submission
Submitting claims electronically may allow health care providers to decrease administrative costs and improve cash flow.
Availity®, LLC is Humana's central gateway for electronic data interchange (EDI) transactions. Humana providers can use the Availity Web portal as a no-cost solution for submitting claims electronically. To register for the Web portal, visit Availity.com and click “Get Started.”
Registered users of Humana.com also have access to a no-cost solution for electronic claims submission through Humana's relationship with ZirMed. Sign in at Humana.com, select "Claims Tools," then choose "Submit Claims and Encounters" to access the ZirMed site.
Health care providers also may file claims electronically through the clearinghouse of their choice. Some clearinghouses and vendors charge a service fee. Contact the clearinghouse for information.
When submitting claims to a clearinghouse, you may use the following payer IDs for Humana:
Please note the following time frames for submitting Medicare Advantage and commercial claims:
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:
When a claim is submitted in error to a carrier or agency other than Humana, the timely filing period begins as of the date the provider was notified of the error by the other carrier or agency.
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.
If your claim rejects at the vendor level, please contact your vendor for assistance.
If you need further assistance with electronic claims submission, please send an email to eBusiness@Humana.com or call your vendor's customer service help line.