Submitting a claim electronically
Healthcare professionals and facilities can use the Availity Portal and electronic data interchange (EDI) services as no-cost solutions for submitting claims electronically. To register for the Availity Portal or to learn more about Availity claims solutions, visit Availity.com., opens new window
Waystar, a ZirMed and Navicure company, offers healthcare providers no-cost solutions for electronic claims submission. In addition, Waystar’s auto-adjudication tool checks claims for accuracy more quickly than a manual review. To get started, visit ZirMed.com., opens new window
Healthcare providers also may file a claim by EDI through the clearinghouse of their choice. Some clearinghouses and vendors charge a service fee. Contact the clearinghouse for information.
If submitting a claim to a clearinghouse, use the following payer IDs for Humana:
- Claims: 61101
- Encounters: 61102
Advanced claims editing
All EDI submissions to Humana pass through Availity. A process known as advanced claims editing (ACE) applies coding rules to a medical claim submitted through the Availity gateway via EDI before the claim enters Humana’s claim payment system. This enables a claim submitter to identify potential coding issues up front, and it reduces processing delays that can result from incomplete or inaccurate claim data.
For more information, review
Electronic batch claims experience streamlined: Advanced claims editing (ACE)., PDF opens new window
Time frames to submit a claim
Please note the following time frames for submitting Medicare Advantage or commercial claims:
Medicare Advantage: Claims must be submitted within one year from the date of service or as stipulated in the provider agreement.
Commercial: Claims must be submitted within 90 days from the date of service if no other state-mandated or contractual definition applies.
If a claim is submitted in error to a carrier or agency other than Humana, the timely filing period begins on the date the provider was notified of the error by the other carrier or agency.
Checking claim status online
Healthcare professionals can check the status of a claim on the Availity Portal. Registration is required for access to the portal. Go to
Availity.com , opens new window
To find out more, please review this
flyer., PDF opens new window
Assistance with claim submission
If your claim is rejected at the vendor level, please contact the vendor for assistance.
If you need further assistance with an electronic claim submission, please call your vendor's customer service help line.
Texas deficient claims
If you are a Texas-based healthcare provider, read this flyer to learn how to check a deficient claim online.
View deficient claims, PDF opens new window