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Making It Easier

Making It Easier for Physicians and Other Healthcare Providers is a library of topics designed to make it easier for you to do business with Humana.

Topics

Tools and Resources for Physicians and Other Healthcare Providers

Updated: October 2021. Learn about Humana’s inventory of useful tools and resources, which can simplify your claims-related and other interactions with Humana. Printable resource guides are included. Runtime: 9:49

View video presentation here, Tools and Resources for Physicians and Other Healthcare Providers,

Claim Disputes and Corrected Claims

Updated: March 2022. Learn about Humana’s processes for medical claim disputes and corrected claims. This information pertains to professional and facility claims submitted for your patients with Humana Medicare Advantage and commercial plans. This presentation includes a printable tip sheet. Runtime: 16:15

View video presentation here, Claim Disputes and Corrected Claims,

Medical Claim Appeals

Updated: March 2022. Learn about Humana’s policy on medical claim appeals for your patients with Humana Medicare Advantage, commercial and Medicaid plans. This presentation includes a printable tip sheet. Runtime: 18:46

View video presentation here, Medical Claim Appeals,

Professional Component and Technical Component (PC/TC)

Updated: March 2022. Learn about Humana’s policies for proper reporting and reimbursement of the professional and technical components of a service for your patients with Humana Medicare Advantage, commercial and select Medicaid plans. This presentation includes a printable tip sheet. Runtime: 12:05

View video presentation here, Professional Component and Technical Component (PC/TC),

Application of Medicare NCD/LCD Guidelines

Updated: March 2022. Learn how Humana administers Medicare national coverage determinations (NCDs), local coverage determinations (LCDs) and related articles for Medicare Advantage plans. This presentation includes a printable tip sheet. Runtime 14:32

View video presentation here, Application of Medicare NCD/LCD Guidelines,

Medical Record Management (MRM) Tool – Benefits of Online Submission:

Updated: February 2022. Learn about the importance of medical record reviews and the benefits of submitting requested medical records online. The information applies to claims submitted for your patients with Humana Medicare Advantage, commercial and Medicaid plans. This presentation includes a printable tip sheet. Runtime: 10:05

View video presentation here, Medical Record Management (MRM) Tool – Benefits of Online Submission,

Modifier 24

Updated: February 2022. Learn about Humana’s policy on the use of modifier 24 when submitting claims for your patients with Humana Medicare Advantage and commercial plans. This presentation includes a printable tip sheet. Runtime: 10:32

View video presentation here, Modifier 24,

Use of Non-Specific Procedure Codes

Updated: February 2022. Learn about Humana’s requirements for submission of non-specific, or unlisted, CPT or HCPCS codes for your patients with Humana Medicare Advantage, commercial and select Medicaid plans. This presentation includes a printable tip sheet. Runtime: 14:47

View video presentation here, Use of Non-Specific Procedure Codes,

Durable Medical Equipment – Guidance Highlights

Updated: February 2022. Learn about Humana’s general guidance related to durable medical equipment, prosthetics, orthotics, and supplies, or DME. This presentation applies to claims submitted for services for your patients with Humana Medicare Advantage and commercial plans. This presentation includes a printable tip sheet. Runtime: 10:04

View video presentation here, Durable Medical Equipment – Guidance Highlights,

Modifier 25

Updated: February 2022. Learn about Humana’s policy on the use of modifier 25 when submitting claims for your patients with Humana Medicare Advantage, commercial and select Medicaid plans. This presentation includes a printable tip sheet. Runtime: 12:20

View video presentation here, Modifier 25,

Procedure-to-Procedure Code Editing

Updated: February 2022. Learn about Humana’s code editing for incidental, mutually exclusive and unbundled code combinations. This information applies to claims for your patients with Humana Medicare Advantage, commercial or select Medicaid plans. This presentation includes a printable tip sheet. Runtime: 14:35

View video presentation here, Procedure-to-Procedure Code Editing,

Modifiers 96 and 97 (Habilitative and Rehabilitative Services)

Updated February 2022: Learn about Humana’s policy requiring the use of modifiers 96 and 97 (habilitative and rehabilitative services) when submitting claims for many of your patients covered by Humana commercial plans. This presentation includes a printable tip sheet. Runtime: 14:22

View video presentation here, Modifiers 96 and 97 (Habilitative and Rehabilitative Services),

Multiple Evaluation and Management (E/M) Services

Updated: January 2022. Learn about Humana’s policy for reimbursement of multiple E/M services for physicians and other professional providers submitting claims for patients with Humana Medicare Advantage, commercial and select Medicaid plans. This presentation includes a printable tip sheet. Runtime: 13:15

View video presentation here, Multiple Evaluation and Management (E/M) Services,

Claim Processing Edit Notifications

Updated: January 2022. Learn about the claim processing edits page and how to access and use claim code-editing information located there as a resource for understanding how Humana processes claims. This presentation applies to claims submitted for services for your patients with Humana Medicare Advantage and commercial plans. This presentation includes a printable tip sheet. Runtime: 8:07

View video presentation here, Claim Processing Edit Notifications,

Chronic Care Management and Principal Care Management Services

Updated: January 2022. Learn about Humana’s policy for coverage of chronic care management, complex chronic care management and principal care management services when submitting claims for your patients with Humana Medicare Advantage and Medicaid plans. This presentation includes a printable tip sheet. Runtime: 15:57

View video presentation here, Chronic Care Management and Principal Care Management Services,

Modifiers 76 and 77

Updated: January 2022. Learn about Humana’s policy on the use of modifiers 76 and 77 to indicate that a service is a repeat procedure. This presentation applies to claims submitted for services for your patients with Humana Medicare Advantage, commercial and select Medicaid plans. This presentation includes a printable tip sheet. Runtime: 10:00

View video presentation here, Modifiers 76 and 77,

Drug Testing and Codes

Updated: December 2021. Learn about Humana’s policies on drug testing for patients with Humana Medicare Advantage, commercial and select Medicaid plans. This is an updated version of a previous presentation. This presentation includes a printable tip sheet. Runtime: 15:26

View video presentation here, Drug Testing and Codes,

Modifiers 59 and X{EPSU}:

Updated: January 2022. Learn about Humana’s policy on the use of Modifier 59 and the X{EPSU} modifiers. This information applies to claims submitted for your patients with Humana Medicare Advantage, commercial and select Medicaid plans. This presentation includes a printable tip sheet. Runtime: 14:14

View video presentation here, Modifiers 59 and X{EPSU},

Availity Essentials Overpayments Tool

Released: January 2022: Learn about the Availity Essentials Overpayments tool, where to find the tool and the benefits of using the tool to manage overpayments identified by Humana. The information applies to claims submitted for your patients with Humana Medicare Advantage (MA), commercial and Medicaid plans. This presentation includes a printable tip sheet. Runtime: 7:16

View video presentation here,

Anatomical Modifiers

Updated: December 2021. Learn about Humana’s policy requiring the use of anatomical modifiers when submitting claims for your patients with Humana Medicare Advantage, commercial and select Medicaid plans. This presentation includes a printable tip sheet. Runtime: 14:00

View video presentation here, Anatomical Modifiers,

Home Health Billing

Updated: January 2022: Learn about Humana’s guidelines for submitting claims for home health services for your patients with Medicare Advantage and commercial plans. This presentation includes a printable tip sheet. Runtime 12:21

View video presentation here, Home Health Billing,

Humana’s Approach to Code Editing

Updated: November 2021. Learn about Humana’s approach to code editing for claims for your patients with Humana Medicare Advantage, commercial and Medicaid plans. This presentation includes a printable overview. Runtime: 11:19

View video presentation here, Humana’s Approach to Code Editing,

Dental Services Covered by Humana MA Plans – Cancer Treatment and Accidental Injury

Updated: December 2021. Learn about Humana’s guidelines for submitting claims for covered, medically necessary, nonroutine dental services required for treatment of cancer or accidental injury for your patients with Medicare Advantage plans. This presentation includes a printable tip sheet. Runtime 8:35

View video presentation here, Dental Services Covered by Humana MA Plans: Cancer Treatment and Accidental Injury,

Emergency Department E/M Reimbursement

Updated: September 2021. Learn about Humana’s policy for reimbursing in-network facility claims for evaluation and management services rendered to patients with Humana Medicare Advantage plans, and for reimbursing claims submitted by all facilities, in-network and out-of-network, for patients with commercial plans. This presentation includes a printable tip sheet. Runtime: 18:58

View video presentation here, Emergency Department E/M Reimbursement,

Billing Hospice Services for VBID Demonstration Plans (2021-2022)

Updated: November 2021. Learn about Humana’s requirements for submitting claims for hospice services provided as part of a value-based insurance design (VBID) demonstration plan. This information applies to claims submitted for your patients with Humana Medicare Advantage in Colorado, Georgia, Kentucky, Ohio, Virginia and Wisconsin. This presentation includes a printable tip sheet. Runtime 16:47

View video presentation here, Billing Hospice Services for VBID Demonstration Plans,

Common Errors – Reporting Diagnosis Codes in the Primary Position

Updated: October 2021. Learn how to avoid some common errors when reporting primary diagnosis codes for claims submitted for your patients with Humana Medicare Advantage, commercial and Medicaid plans. This presentation includes a printable tip sheet. Runtime: 16:44

View video presentation here, Common Errors – Reporting Diagnosis Codes in the Primary Position,

Humana’s Maximum Unit Values

Updated: August 2021. Learn about Humana’s approach to maximum unit values for your patients with Humana Medicare Advantage, commercial and Medicaid plans. This presentation includes a printable tip sheet. Runtime: 12:24

View video presentation here, Humana’s Maximum Unit Values,

Medicare Advantage Preventive Services

Updated: September 2021. Learn about Humana’s policies for preventive services for your patients with Humana Medicare Advantage plans. Topics covered include the Initial Preventive Physical Examination (IPPE), Annual Wellness Visit, Annual Preventive Physical Exam and Well Woman Exam. This presentation includes a printable tip sheet. Runtime: 20:04

View video presentation here, Medicare Advantage Preventive Services,

Medicare Advantage Preventive Services – FQHC

Updated: September 2021. Learn about Humana’s policies for preventive services rendered in federally qualified health centers (FQHCs) for your patients with Humana Medicare Advantage plans. Topics covered include the Initial Preventive Physical Examination (IPPE), Annual Wellness Visit, Annual Preventive Physical Exam and Well Woman Exam. This presentation includes a printable tip sheet. Runtime: 21:35

View video presentation here, Medicare Advantage Preventive Services – FQHC,

Medicare Advantage Preventive Services – RHC

Updated: September 2021. Learn about Humana’s policies for preventive services rendered in a rural health clinic (RHCs) for your patients with Humana Medicare Advantage plans. Topics covered include the Initial Preventive Physical Examination (IPPE), Annual Wellness Visit, Annual Preventive Physical Exam and Well Woman Exam. This presentation includes a printable tip sheet. Runtime: 20:41

View video presentation here, Medicare Advantage Preventive Services – RHC,

Authorizations - Avoid Claim Denials

Released: September 2021. Learn about the importance of obtaining an authorization or preauthorization, when required; about options for obtaining an authorization or preauthorization; and about the appropriate steps to take when an authorization- or preauthorization-related claim is denied. The information in this presentation applies to claims submitted for your patients with Humana Medicare Advantage and commercial plans. This presentation includes a printable tip sheet. Runtime 17:01

View video presentation here, Authorizations - Avoid Claim Denials,

Genetic Testing - Billing and Coding for Medical and Laboratory Providers

Updated: August 2021. Learn about Humana’s billing expectations for coverable medically necessary genetic testing and how Humana will adjudicate and reimburse claims for those services. This information applies to claims submitted for your patients with Humana Medicare Advantage, select commercial and select Medicaid plans. This presentation includes a printable tip sheet. Runtime 21:13

View video presentation here, Genetic Testing: Billing and Coding for Medical and Laboratory Providers,

Bilateral Services and Modifier 50

Updated: August 2021. Learn about Humana’s policies for reporting bilateral services and the use of modifier 50 when submitting claims for your patients with Humana Medicare Advantage, commercial and select Medicaid plans. This presentation includes a printable tip sheet. Runtime: 10:16

View video presentation here, Bilateral Services and Modifier 50,

Understanding an Explanation of Remittance (EOR)

Updated: May 2021. Understand your Humana EOR for patients with Humana Medicare Advantage, commercial and Medicaid plans. This presentation includes a printable tip sheet. Runtime: 18:24

View video presentation here, Understanding an Explanation of Remittance (EOR),

Disclaimer: The information in these presentations is general and does not represent individual member benefits, coverage or payment determinations made by Humana; nor does it supersede any determination made by Humana. It does not guarantee claim payment and should not be used as legal advice or a legal opinion. As claims policies and guidelines change, the information in these presentations may be updated to reflect those changes. For Humana member claim or benefit information, please call the number on the back of the member’s ID card.
Close up of a stethoscope on top of a clipboard and a doctor in the background.