Valid National Provider Identifiers (NPIs) are required on an electronic claim submission and strongly encouraged on a paper claim submission. If a paper claim does not have all necessary NPIs, it may be denied or be subject to delays in adjudication.
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 , 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 , 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:
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 , PDF opens new window
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.
Healthcare professionals can check the status of a claim on the Availity Portal. Registration is required for access to the portal. Go to , opens new window
To find out more, please review this , PDF opens new window
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.
If you are a Texas-based healthcare provider, read this flyer to learn how to check a deficient claim online.
To decrease administrative costs and improve cash flow, clinicians and facilities are encouraged to use electronic claim submission whenever possible.
If it is necessary to submit a paper claim, please use the addresses below. Keep in mind, however, that the claim or encounter mailing address on the member’s identification card is always the best to use.
Valid National Provider Identifiers (NPIs) are required on an electronic claim and strongly encouraged on a paper claim. If a paper claim does not have all necessary NPIs, it may be denied or be subject to delays in adjudication.
Humana medical claims:
Humana Claims
P.O. Box 14601
Lexington, KY 40512-4601
HumanaDental® claims:
HumanaDental Claims
P.O. Box 14611
Lexington, KY 40512-4611
Humana encounters:
Humana Encounters
P.O. Box 14605
Lexington, KY 40512-4605
Claim overpayments:
Humana
P.O. Box 931655
Atlanta, GA 31193-1655
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.
Humana reimburses for roster bills for select vaccinations. Healthcare providers should follow the billing guidelines below when submitting roster bills to Humana for those select vaccinations:
Please send a roster bill to the following address:
Humana
Attn: Claims
P.O. Box 14601
Lexington, KY 40512-4601
If you are a Texas-based physician or other healthcare provider, read this flyer to learn how to check a deficient claim online.
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