As sequestration reductions have been imposed by the Centers for Medicare & Medicaid Services (CMS), Humana has implemented the same reductions to network and non-network provider payments. All non-network and network health care providers who are reimbursed using a fee schedule based off the Medicare payment system, percentage of Medicare Advantage premium or Medicare allowed amount (e.g., resource-based relative value scale [RBRVS], diagnosis-related group [DRG], etc.) will have the same sequestration reduction applied in the same manner as CMS. This reduction applies to all Medicare Advantage plans.
The “sequestration reduction amount” for each affected claim will be identified on the explanation of remittance health care providers receive from Humana. Questions may be directed to Humana provider relations by calling 1-800-626-2741, Monday through Friday between 8 a.m. and 5 p.m. Central time. Additionally, health care providers may refer to the Centers for Medicare & Medicaid Services’ Provider e-News (March 8, 2013) (link opens in new window) for more information.
Health care providers without Humana Medicare contracts must submit all home health services claims on Form CMS-1450 (or the electronic transaction equivalent). Claims submitted on Form CMS-1500 (or the electronic transaction equivalent) will be rejected, and the health care provider will be required to resubmit the charges on Form CMS-1450.
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