2019 Humana Medicare Advantage Health Maintenance Organization (HMO) plan
The following documents contain information on HMO and HMO point-of-service (HMO-POS) plans and HMO Special Needs Plans (SNPs).
The resources below give healthcare providers information about the types of Medicare Advantage plans Humana offers for individual Medicare beneficiaries. These include operational and reimbursement guidelines, provider qualifications and requirements, frequently asked questions and other information.
The provider materials below are for the 2019 plan year.
2019 Humana Medicare Advantage Preferred Provider Organization (PPO) Plan
2019 Humana Medicare Advantage full and partial networks private-fee-for-service (PFFS) plans
Full and partial networks PFFS electronic claims flyer, PDF opens new window
Full and partial networks PFFS FAQs, PDF opens new window
Medicare Advantage PFFS plan model terms and conditions of payment, PDF opens new window
Other Medicare Advantage resources
Below are two programs to which Humana Medicare Advantage members may have access as part of their plan.
Medicare supplement insurance
This document explains Medicare supplement insurance (also known as Medigap) basics. It includes a chart of the standard Medicare supplement plans.
Medicare Outpatient Observation Notice (MOON)
When a Medicare beneficiary receives outpatient observation services from a hospital or critical access hospital (CAH) for more than 24 hours, he or she (or the beneficiary’s authorized representative) must receive a MOON. The written MOON and a verbal explanation of the notice must be delivered no later than 36 hours after services were initiated. The MOON is mandated by the Federal Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act), passed on Aug. 6, 2015.
Important notes:
- The MOON may be delivered before a beneficiary receives 24 hours of observation services as an outpatient
- If the beneficiary is transferred, discharged or admitted, the MOON still must be delivered no later than 36 hours following initiation of observation services
- The start time of observation services is measured as the clock time observation services are initiated in accordance with a physician’s order
Hospitals and CAHs must use one of the following Office of Management and Budget (OMB)-approved MOONs, which can be downloaded on the Centers for Medicare & Medicaid Services (CMS) website:
Beneficiary Notices Initiative (BNI) for Moon, opens new window
Instructions on how to fill out CR9935 MOON, PDF opens new window
Additional information about CR9935 Moon, PDF opens new window