Electronic data interchange (EDI) helps healthcare providers and Humana exchange information quickly and efficiently. EDI can speed up processing time and reduce cost and errors.

Accepted Health Insurance Portability and Accountability Act (HIPAA) transactions

Humana accepts the following HIPAA transactions:

  • Healthcare Claim: Professional (837p)
  • Healthcare Claim: Institutional (837i)
  • Healthcare Claim: Dental (837d)
  • Healthcare Eligibility Benefit Inquiry and Response (270/271)
  • Healthcare Services Review and Response (278)
  • Healthcare Services Inquiry and Response (278)
  • Healthcare Claim Payment/Advice (835)
  • Healthcare Claim Status Request and Response (276/277)
  • Payroll Deducted and Other Group Premium Payment for Insurance Products (820)
  • Benefit Enrollment and Maintenance (834)

Getting started

Humana uses Availity as its exclusive clearinghouse for managing EDI transactions. Physicians and other healthcare professionals should contact their current clearinghouse vendor to discuss their ability to support EDI, as well as associated costs, time frames for implementation, etc.

Trading partner registration

Before submitting or receiving EDI transactions, you must register as a trading partner with Availity. For registration instructions, see the Availity® Health Information Network Batch Electronic Data Interchange (EDI) Standard Companion Guide: http://www.availity.com/documents/edi_guide.pdf, PDF opens new window. If you have questions not answered in the guides, please visit Availity.com, opens new window or call 800‐282‐4548.

Availity requires that all vendors and high‐volume senders pass HIPAA compliance and integration testing before submitting transactions to Availity. This testing ensures that your translated HIPAA ASC X12 transactions can pass HIPAA standards validation and any applicable payer‐specific edits that Availity performs on the payer’s behalf. This testing is coordinated through the Availity Client Services Department (800‐282‐4548).

Companion guides

Healthcare providers wanting technical guidance with implementation of HIPAA in relation to Humana transactions can refer to these companion guides.