Claim resources

Humana supports health care professionals’ administrative needs with authorization and referral information, electronic claim submission, claims edits, guidelines and more.

A doctor writes on a chart.

Claims and payments

Authorizations and referrals

Get details on how to request preauthorization and submit notification for various tests and procedures, view online submission options and access state-specific forms.

Claims and encounter submission

Learn about the options for submitting claims electronically, the time frames for claim submission, claim status checks and more.

Claims processing edits

Access a schedule of changes planned for our claims payment systems.

Interactive voice response system

The IVR system provides automated information on claims, benefits and more, 24 hours a day, seven days a week.

Preauthorization and notifications

List of services and medications for which preauthorization may be required for patients with Medicaid, Medicare Advantage, dual Medicare-Medicaid and commercial coverage.

Claims coding

Download claim coding and payment inquiry process guidelines.

Claims payment policies

Learn about reimbursement methodologies and acceptable billing practices.

Grievances and appeals

Access information about medical claim payment reconsiderations and member appeals for Humana participating and nonparticipating physicians, hospitals and other health care providers.

Electronic claims payments

Learn about the options Humana offers.

Payment resources

Learn about real-time claim adjudication, processing transactions and more.

Payment integrity and disputes

Find policies and procedures to learn how Humana ensures claims accurracy and handles payment discrepancies.

Making it Easier

A series of educational presentations about Humana’s claims payment policies and processes.