What's new

What's New

Read key updates for health care providers and their staff members.

Close-the-Gaps Sweepstakes announced

Humana will give $560,000 over 16 weeks beginning in November to general practice physicians who close HEDIS Stars measure gaps in care.

Updated Preauthorization and Notification Lists for 2016 Available

On Jan. 18, 2016, Humana will update preauthorization and notification lists for all commercial fully insured plans, Medicaid plans and Medicare Advantage (MA) and dual Medicare-Medicaid plans.

2016 Professional and Facility Claim Code Edit and Policy Updates Announced

When changes to the claim payment system may adversely impact how a health care provider is reimbursed for the services that he or she provides to Humana members, Humana provides advance notice at least 90 days prior to implementation.

Use Flu Vaccinations and Save Lives

Flu and pneumonia vaccinations are key to patient health and thus have become important quality metrics for programs such as the Healthcare Effectiveness Data and Information Set (HEDIS) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS).

Changes to 2016 Formularies Announced

Effective Jan. 1, 2016, certain drugs will have new limitations or will require utilization management.

Member approval notification process changes

Humana is changing its policy regarding enrollee notification for standard organization determinations due to recent clarification from the Centers for Medicare & Medicaid Services (CMS).

National Drug Codes (NDCs) required on claims

All Healthcare Common Procedure Coding System (HCPCS) drug codes must be submitted with the corresponding valid national drug code (NDC) on claims for all lines of business.

RightSource set to become "Humana Pharmacy"

RightSource, Humana’s prescription mail-order pharmacy service, soon will be called “Humana Pharmacy.”

Find Paid-through dates on Humana.com

Look-up of the paid-through date for both on- or off-exchange marketplace members is now available via the secure provider Web portal on Humana.com.

Compliance Requirements for Health Care Providers and CMS Mandates Humana-contracted entities to complete compliance requirements

Medicare compliance requirements

The Centers for Medicare & Medicaid Services (CMS) mandates that all Humana-contracted entities, including those contracted with Humana subsidiaries, complete compliance requirements.

Addressing fraud, waste and abuse

Addressing fraud, waste and abuse

Learn how to detect and prevent fraud, waste and abuse with free training materials, tools and resources from Humana.

Learn more about Humana’s commitment

Humana’s YourPractice

This bimonthly publication provides updates that make it easier for you to do business with Humana.

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