Physicians and other healthcare providers are increasingly concerned about the impact consumer-directed healthcare plans and high-deductible health plans have on their ability to collect timely payment from their patients. Humana offers two related tools to help providers with this: an online benefit estimator tool and real-time adjudication (RTA).

Estimating patient responsibility

Humana’s benefit estimator is a secure web tool you can use to create a personalized estimate of a patient’s payment responsibility. The estimate is specific to the healthcare provider and treatment/service and based on a real-time snapshot of the patient’s benefits. This facilitates financial discussions between you and your patients so that payment arrangements can be made at the time of service.

To take advantage of this tool, you must be a registered user of the Availity portal.

Locating this tool on the Availity portal

On the Availity portal, you can access the benefit estimator through the “Patient Cost Estimator” button:

  • Log in to the Availity portal at, opens new window with your Availity username and password
  • Open the “Patient Registration” drop-down menu from the top navigation bar
  • Select the “Eligibility and Benefits Inquiry” link to look up your patient’s coverage
  • On the Eligibility and Benefits results, select the “Patient Cost Estimator” button at the top of the screen

Real-time adjudication

RTA allows a healthcare provider to bill for service before the patient leaves the office and to receive a fully adjudicated response from the health plan at the time of service. (Please note that claims adjudicated in real time are still subject to post-adjudication review and corrections.)

Humana has worked with a number of practice management systems and clearinghouses, including athenahealth, Inc., and Availity, to offer RTA.

Will RTA work for your office?

RTA can be advantageous to all parties involved in the healthcare industry, especially healthcare providers concerned about the potential for bad debt. However, several factors may impact your ability to implement RTA:

  • Claims must be ready for submission at the time services are rendered
  • Your practice management systems must be able to submit claims in real time
  • Some RTA solutions require healthcare providers to manually type professional claims into an entry screen, creating duplicate work for office staff
  • Many clearinghouses are unable to transmit claims in real time