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