For physicians, office managers and billing staff

Revised provider manual goes into effect

Two doctors smile as they discuss information on a tablet.

Humana provider manual revisions make it more user friendly

A revised version of the Humana Provider Manual is now available and became effective on July 1, 2019. It was last updated in 2013. It’s important for all contracted healthcare providers and administrators to review the new provider manual, as your participation agreement with the Humana or ChoiceCare network contains a compliance obligation with the provisions of the manual.

Overall, the provider manual has been reorganized and streamlined to make it more user friendly. Similar subjects have been grouped together to help you quickly locate the information you need. For example, there is now a separate section that includes information on both utilization management and referrals.

Additional notable revisions in this edition include the following:

  • Restructuring of the Grievance and Appeal section to detail the specific characteristics of: 1) member grievance/appeals, 2) provider claims dispute requests and 3) provider termination appeals.
  • Additional language to describe healthcare providers’ contractual obligations to report demographic changes (e.g., name, number, address, new physicians) quickly to Humana. This information confirms that Humana’s network filings are accurate and provider communications can be shared effectively.
  • An updated Compliance/Ethics section covers liability insurance; fraud, waste and abuse requirements; notification requirements; conflicts of interest and Medicare obligations.

To request a printed version of the manual, please contact your local market office. Requests must include the name of the provider business, the name of person to receive the manual and the complete address.