What's New

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

New Physician Finder Plus Capabilities Bring More Information, Functionality to Users

Enhancements to the Physician Finder Plus tool allow searches for medical, behavioral and dental health care providers in one place.

Physician Finder Plus Enhancements

Delays Announced for SGR Cuts, ICD-10 Implementation

H.R. 4302, Protecting Access to Medicare Act of 2014, delays scheduled cuts in physician payments under Medicare and CMS from enforcing any mandate to switch to the newer ICD-10 system until at least Oct. 1, 2015.

SGR/ICD-10 Delays

Check Member Eligibility Before Providing Services

Now, more than ever, health care providers are encouraged to check member eligibility via the Web or telephone prior to providing services.

More on checking eligibility

Pediatric Vision Benefits

The Affordable Care Act mandates certain routine vision benefits for members up to age 19. (This age may vary by state.) Learn more about these benefits.

Pediatric Vision Benefits Overview (link opens in new window) 

Humana offers free outreach to potential dual-eligible members

The Medicare Savings Program can save Medicare beneficiaries at least $104.90 per month, but many don't know about the program or may need help applying. Find out how to direct patients to a free Humana service that can help them apply.

Learn how you can help (link opens in new window) 

Provider Manual Revisions Affect Laboratory Results Data Sharing and Provider Reimbursement

One of the updates to Humana's provider manual affects the submission of lab results data to Humana and the potential impact to providers.

Lab Results Data

2014 Updates to Commercial and Medicare Advantage Preauthorization and Notification Lists Announced

Humana-contracted health care providers were recently notified of updates to Humana's preauthorization and notification lists for all commercial fully insured plans and Medicare Advantage plans, effective Jan. 18, 2014.

Updated Preauthorization

Preauthorization and Concurrent Review Process for Medicare Advantage Inpatient Admissions Updated

Humana recently notified affected Humana-contracted health care providers that it is changing its preauthorization and concurrent review process for Medicare Advantage HMO and PPO inpatient admissions, effective Jan. 18, 2014.

Inpatient Admissions

Revised Provider Manual Effective Oct. 21, 2013

Humana has posted a revised version of its Provider Manual. The new version of Humana's Provider Manual will be effective on October 21, 2013.

Revised Provider Manual

Find Humana Claims Payment Policies for Medicare Advantage and Commercial Products Online

Humana is publishing its claims payment policies online.

Learn More About Routine Physical Exams for Medicare Advantage Members

In the years following the “Welcome to Medicare” physical exam, Humana Medicare Advantage members are covered for a routine physical by a single physician once per 365 days at no cost (as long as applicable in-network requirements are met).

Advantage Exams

Inpatient Transfer Adjustments Automated for Select Claims

Short-term, acute-care hospitals may be affected by automation of transfer adjustments for some Medicare Advantage and commercial inpatient claims.

Inpatient Transfer

Medicare DMEPOS Competitive Bidding Program

Non-network Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) providers subject to original Medicare DMEPOS Competitive Bidding Program

Find out how this process is being implemented for Humana Medicare Advantage plans.

DMEPOS Bidding Program

Urgent Care Centers Provide Affordable, Medically Appropriate Care

Advising patients about when to use urgent care centers and when to go to the emergency room can help improve both access to care and proper utilization of health system resources.

Urgent Care Information

Sequestration Reduction Information for Healthcare Providers

Sequestration Information

Find out how sequestration reductions are affecting health care providers’ payments.

Sequestration Reduction Information

Prepare Now to Transition to ICD-10

Learn more about Humana's readiness plan and find answers to your frequently asked questions for ICD-10.

Prepare now to transition to ICD-10

Humana Promotes Medicare Advantage Member and Primary Physician Relationship

As Humana continues its progress in connecting Medicare Advantage PPO members to primary physicians, beginning in plan year 2014, Medicare Advantage (MA) HumanaChoice(PPO) plans will require that members select a primary physician to focus on the member's health care needs and coordinate care as needed. Although members are required to select a primary physician, members do not need to get referrals for services or to see other doctors.

2014 MA PPO primary physician requirement

New Professional and Facility Claim Code Edits

Find out more about updates to Humana’s professional and facility claims payment systems.

Code Edit

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.

Compliance Requirements for Healthcare Providers

High-risk medications impacted by formulary changes

Medication formulary changes

Effective Jan. 1, 2013, certain drugs under the Humana Medicare formularies will have new limitations or will require utilization management for the 2013 plan year.

Formulary Changes

Understanding the "Two Midnights" Standard for Admissions

Learn more about coverage of inpatient admissions that cross "two midnights."

Two Midnights

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

Humana’s YourPractice

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

View the current issue. (link opens in new window)