Check Member Eligibility Before Providing Services
More on checking eligibility
Now, more than ever, health care providers are encouraged to check member eligibility via the Web or telephone prior to providing services.
Pediatric Vision Benefits
Pediatric Vision Benefits Overview (link opens in new window)
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.
Humana offers free outreach to potential dual-eligible members
Learn how you can help (link opens in new window)
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.
Provider Manual Revisions Affect Laboratory Results Data Sharing and Provider Reimbursement
Lab Results Data
One of the updates to Humana's provider manual affects the submission of lab results data to Humana and the potential impact to providers.
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.
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.
Revised Provider Manual Effective Oct. 21, 2013
Revised Provider Manual
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.
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).
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.
Medicare DMEPOS Competitive Bidding Program
Non-network Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) providers subject to original Medicare DMEPOS Competitive Bidding Program
DMEPOS Bidding Program
Find out how this process is being implemented for Humana Medicare Advantage plans.
Urgent Care Centers Provide Affordable, Medically Appropriate Care
Urgent Care Information
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.
Sequestration Reduction Information for Healthcare Providers
Sequestration Reduction Information
Find out how sequestration reductions are affecting health care providers’ payments.
Prepare Now to Transition to ICD-10
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.
Humana Promotes Medicare Advantage Member and Primary Physician Relationship
2014 MA PPO primary physician requirement
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.
New Professional and Facility Claim Code Edits
Find out more about updates to Humana’s professional and facility claims payment systems.
Compliance Requirements for Health Care Providers and CMS Mandates Humana-contracted entities to complete compliance requirements
Medicare compliance requirements
Compliance Requirements for Healthcare Providers
The Centers for Medicare & Medicaid Services (CMS) mandates that all Humana-contracted entities, including those contracted with Humana subsidiaries, complete compliance requirements.
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.
Understanding the "Two Midnights" Standard for Admissions
Learn more about coverage of inpatient admissions that cross "two midnights."