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Claim Processing Edits

Humana periodically updates its policies and claims payment systems to be aligned with correct-coding initiatives, as well as these national benchmarks and industry standards:

  • Centers for Medicare & Medicaid Services (CMS) guidelines
  • American Medical Association (AMA) Current Procedural Terminology (CPT®)
  • Health Care Common Procedure Coding System (HCPCS)
  • International Classification of Diseases, 9th Edition (ICD-9) and 10th Edition (ICD-10)

These updates support Humana's continuing efforts to process claims accurately.

Use the search feature to look for specific edits. To see edits for Puerto Rico, select the “Display edits for the Puerto Rico market only” option.

To search by keyword, enter a search term (such as “ambulance” or “Docetaxel”).

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Display new edits that have not yet been implemented or have recently been implemented.

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See Special Announcements and General Reminders for these edits.

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See previous compiled updates 

View all previously implemented edits, 2008–2015

View previous edits for Puerto Rico

(PDF documents)