Humana sometimes reviews an itemized bill for an inpatient admission to determine whether supplies, items and services specified on the itemized bill are separately billable. If an itemized bill is not provided when requested, or if improper billing is identified during the review of an itemized bill, one or more of the following outcomes may result:
Humana’s Itemized Bill Review for Inpatient Routine Services policy can be found on the Humana claims payment policies page. Type “itemized billing” in the search box.
The following is a list of the previous claim processing edits and other notifications related to the Itemized Bill Review for Inpatient Routine Services policy:
Per Humana’s provider manuals:
The following applies only to hospital reimbursement: Hospital agrees to comply with Humana’s hospital audit and prepayment review policies, which can be found at Humana.com, Providers’ section.
Claim processing edit update notifications: