Electronic submission

Submitting claims electronically

Healthcare professionals and facilities can use the Availity Provider Portal and electronic data interchange (EDI) services as no-cost solutions for submitting claims electronically. To register for the Availity portal or learn more about Availity claims solutions, visit Availity.com (link opens in new window).

Waystar, a ZirMed and Navicure company, offers healthcare providers no-cost solutions for electronic claims submission. In addition, Waystar’s auto-adjudication tool checks claims for accuracy more quickly than a manual review. To get started, visit ZirMed.com (link opens in new window) and click “Contact Us” or call 1-877-494-7633.

Healthcare providers also may file claims by electronic data interchange (EDI) through the clearinghouse of their choice. Some clearinghouses and vendors charge a service fee. Contact the clearinghouse for information.

When submitting claims to a clearinghouse, you may use the following payer IDs for Humana:

  • Claims: 61101
  • Encounters: 61102

Advanced Claims Editing (ACE)

All EDI submissions to Humana pass through Availity. A process known as Advanced Claims Editing (ACE) applies certain coding rules to batch medical claims submitted through the Availity gateway via EDI before they enter Humana’s system. This allows claims submitters to identify potential coding issues up front and reduce processing delays that can result from incomplete or inaccurate claims data.

For more information, review “Electronic batch claims experience streamlined: Advanced Claims Editing (ACE)(link opens in new window)."

Time frames for claim submission

Please note the following time frames for submitting Medicare Advantage and commercial claims:

Medicare Advantage: Claims must be submitted within one calendar year from the date of service.

Commercial: Claims must be submitted within the time stipulated in the provider agreement or the applicable state law. Generally, these claims must be submitted within:

  • 180 days from the date of service for physicians
  • 90 days from the date of service for facilities and ancillary providers

When a claim is submitted in error to a carrier or agency other than Humana, the timely filing period begins as of the date the provider was notified of the error by the other carrier or agency.

Checking claim status online

Healthcare professionals can check the status of submitted claims on the Availity Provider Portal. Registration is required for access to the portal; go to Availity.com (link opens in new window) to register.

To find out more, please review this flyer (link opens in new window).

Assistance with claim submission

If your claim rejects at the vendor level, please contact your vendor for assistance.

If you need further assistance with electronic claims submission, please call your vendor's customer service help line.