Payment collection resources

Health care providers are increasingly concerned about the impact consumer-directed health care plans and high-deductible health plans have on their ability to collect timely payment from their patients. Humana offers two tools for providers: an online benefit estimator tool and real-time adjudication. 

Estimating patient responsibility

Humana's benefit estimator is a secure Web tool you can use to create a personalized estimate of a patient's payment responsibility. The estimate is specific to the provider and treatment/service and based on a real-time snapshot of the patient's benefits. This facilitates financial discussions between you and your patients so that payment arrangements can be made at the time of service.

To take advantage of this tool, log into the secure provider website on Humana.com or Availity.com, using your user ID and password. Then, follow these instructions:

For Humana.com

  • Choose the “Eligibility & Benefits” icon.
  • Select your provider group.
  • Look up the member using the “Eligibility Search” screen.
  • When you see the member’s “Coverage Detail” screen, select the “Benefit Estimator” button at the top or bottom of the page.

For Availity.com

  • Select “Eligibility and Benefits” in the left column.
  • Choose the “Eligibility and Benefits Inquiry” link.
  • Fill out the “Eligibility & Benefits Inquiry” screen.
  • Select the “Patient Cost Estimator” button at the top of the screen.

For more information about this or other Web tools, please send an email to eBusiness@Humana.com.

Real-time adjudication

Real-time adjudication (RTA) allows a health care provider to bill for service before the patient leaves the office and to receive a fully adjudicated response from the health plan at the time of service.

Humana can adjudicate claims in real time for some of its health plans. Members on these plans have been assigned unique member identifiers (UMIDs) that consist of nine digits followed by a two-digit suffix. The UMID for these members usually begins with zeros (example: 000123456-01). The member's UMID can be found on the member's Humana identification card. Claims that are adjudicated in real time are still subject to post-adjudication review and corrections.

Humana has worked with a number of practice management systems and clearinghouses, including Athena and Availity, to offer RTA.

Will RTA work for your office?

RTA can be advantageous to all parties involved in the health care industry, especially providers concerned about the potential for bad debt. However, several factors may impact your ability to implement RTA:

  • Providers must have claims ready for submission at the time services are rendered.
  • Providers' practice management systems must be able to submit claims in real time.
  • Some RTA solutions require providers to manually type professional claims into an entry screen, creating duplicate work for office staff.
  • Many clearinghouses are unable to transmit provider claims in real time.

Explore your options

Humana’s e-business consultants can help you explore your options for using the benefit estimator or RTA. To learn more, please send an email to eBusiness@Humana.com.