Payments information

This web page offers information about processes that may impact the payments you receive from Humana. It also provides links to resources that can help to improve cash flow, reduce administrative expenses and improve operational efficiency.

Payment collection

Payment collection resources

Learn about Humana’s benefit estimator and real-time adjudication.

Humana Access® Visa® Debit Card

The card can be used to pay for covered expenses out of an eligible member’s account.

Sequestration reduction

As sequestration reductions have been imposed by the Centers for Medicare & Medicaid Services (CMS), Humana has implemented the same reductions to network and non-network provider payments. All non-network and network health care providers who are reimbursed using a fee schedule based on the Medicare payment system, percentage of Medicare Advantage premium or Medicare allowed amount (e.g., resource-based relative value scale [RBRVS], diagnosis-related group [DRG], etc.) will have the same sequestration reduction applied in the same manner as CMS. This reduction applies to all Medicare Advantage plans.

The “sequestration reduction amount” for each affected claim will be identified on the explanation of remittance health care providers receive from Humana. Questions may be directed to Humana provider relations by calling 1-800-626-2741, Monday through Friday between 8 a.m. and 5 p.m. Central time. Additionally, health care providers may refer to the Centers for Medicare & Medicaid Services’ Provider e-News (March 8, 2013) (link opens in new window)  for more information.

Billing for home health services

Home health providers not contracted with Humana Medicare must use Form CMS 1450. Form CMS 1450, the UB-04, is used by institutional health care providers, including home health agencies, to bill Original Medicare. Likewise, Humana’s Medicare Advantage (MA) plans require health care providers without contracts to submit all home health services on Form CMS 1450 (or the electronic transaction equivalent).

Unless it is submitted by a health care provider specifically contracted for Form CMS 1500, a Humana Medicare Advantage plan will deny home health services submitted on Form CMS 1500, because the submission of the form was improper. Humana will require the health care provider to resubmit charges for those services on Form CMS 1450 (or the electronic transaction equivalent).

Additional CMS billing requirements for home health include, but are not limited to, the following.

  • Submitting the home health resource group (HHRG) with revenue code 023
  • Submitting the treatment authorization code (TAC), which is obtained through the Medicare OASIS system
  • Submitting the core-based statistical area (CBSA) where services were rendered (submitted with value code 61)
  • Using an appropriate home health prospective payment system (PPS) bill type
  • Billing each visit on a separate claim line
  • Billing each visit with the appropriate CMS-designated revenue and Healthcare Common Procedure Coding System (HCPCS) code combinations
  • Billing units appropriate for the description of the HCPCS code (e.g., CMS visit G-codes represent 15-minute increments of service)
  • Billing a claim line for nonroutine supplies (NRS) when the HHRG indicates NRS were provided
  • Billing CMS-required informational Q-codes

Electronic Submission Information

Humana encourages providers to submit their claims electronically.

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Claim & Encounter Addresses

View a list of addresses for providers to default to when submitting paper claims to Humana.

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