Humana publishes its claim payment policies online. The information about reimbursement methodologies and acceptable billing practices may help physicians, other healthcare providers, and their billing offices bill claims more accurately. This could reduce delays, rebilling and requests for additional information. Find the policies at Humana claims payment policies.

New policy:

  • COVID-19 Telehealth and Other Virtual Services

Updated policies:

  • After-hours Charges
  • DME Capped Rental
  • DME Oxygen
  • DMEPOS Proof of Delivery Documentation
  • Modifier 62
  • National Drug Code (NDC) Billing Requirement

Clarification of time frames for submitting a commercial claim

Humana’s standard time frame to submit a commercial claim is 90 days from the date of service. We may apply this standard to commercial claims if no other state-mandated or contractual definition applies. We may reject a claim received after this time. This timeframe is referred to commonly as the “timely filing” or “proof of loss” period.

Humana continues code-editing updates in 2020

As part of Humana’s ongoing claim-process improvement efforts, we continue to update our claim payment systems to better align with American Medical Association Current Procedural Terminology (CPT®), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases (ICD) code sets. We also align our system with other sources, such as Centers for Medicare & Medicaid Services (CMS) guidelines, correct-coding initiatives, Humana policy, national benchmarks and industry standards.

We post notifications of upcoming changes on the first Friday of each month. These notifications inform providers that we plan to make changes to some of our code editing rules or claim payment processes. Each notification includes an implementation date for that update.

To view these changes and to find additional information about claim policy updates and how to submit code-editing questions, please visit Humana.com/edits.

Note for California physicians and healthcare providers: Code-edit updates do not affect any contractual obligation with a contracted independent practice association (IPA). They pertain only to participation with Humana’s ChoiceCare Network contract.