Electronic submission

Electronic claims submission

Submitting claims electronically may allow health care providers to decrease administrative costs and improve cash flow.

Submitting claims online through Availity®

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.

Submitting claims online through ZirMed®

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.

Clearinghouse information

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:

  • Claims: 61101
  • Encounters: 61102

Time frames for claim submission

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:

  • 180 days from the date of service for physicians.
  • 90 days from the date of service for facilities and ancillary providers.

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.

Valid NPI required on all 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.

Checking claim status online

Health care professionals can check the status of submitted claims on the Availity Web Portal or the secure Humana.com portal (registration required).

  • For access to the Availity Web Portal, go to Availity.com and register.
  • If you’re registered for the Humana.com secure portal, you can use the “Claims Search” tool to check claim status.

Assistance with claim submission

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.