Effective Jan. 1, 2017, for claims with dates of service (DOS) Jan. 1, 2017, and onward, long-term services and supports (LTSS) providers need to follow new guidance for claims submission:
- To submit claims online through the Availity Web Portal (registration required), select “Humana LTC” as the payer after login.
- To submit claims through a clearinghouse, use payer ID 61115. If a different payer ID is used, claims will be rejected or denied.
- To submit paper claims, send them to the following address:
Humana LTSS Claims P.O. Box 14732 Lexington, KY 40512-4732
For more information, refer to the new provider billing guide:
Long-term Services and Supports (LTSS) Provider Billing Guide (1.07 Mb) – Effective Jan. 1, 2017
The documents below highlight the key points related to Humana’s Virginia Demonstration policies and procedures and is an extension of participating health care providers’ contracts. It is intended to be a guideline to facilitate and inform health care providers on what the Virginia Demonstration program is about, what Humana needs from health care providers and what health care providers can expect from Humana.
- Virginia Commonwealth Coordinated Care Appendix (310 KB) – Effective Jan. 1, 2017
- Virginia Commonwealth Coordinated Care Appendix (1.06 MB) – Effective May 15, 2015
Virginia Commonwealth Coordinated Care (CCC) Appendix Bulletins
- Information regarding coverage expansion for Substance Abuse Residential Treatment (223 Kb) – Effective April 1, 2017
- Information regarding respite care coverage (268 Kb) – Effective May 1, 2016
- Information for noncovered services, member transfers and member grievances and appeals (216 Kb) – Effective March 1, 2016
Medicare-Medicaid preauthorization and notification list
The document below lists services and medications for which preauthorization may be required for Humana dual Medicare-Medicaid members in Virginia. Please review the detailed information at the top of the lists for exclusions and other important information before submitting a preauthorization request.
- Jan. 23, 2017, Medicare and Dual Medicare-Medicaid Plans Preauthorization and Notification List – English (726 Kb)
- Jan. 18, 2016, Medicare and Dual Medicare-Medicaid Plans Preauthorization and Notification List – English (673 Kb)
Previous versions of the list can be found here.
Humana Gold Plus Integrated Prescription Drug Guide
- 2016 Prescription Drug Guide – English (1.41 MB)
- 2016 Prescription Drug Guide – Spanish (1.46 MB)
- 2017 Prescription Drug Guide – English (3.15 MB)
- 2017 Prescription Drug Guide – Spanish (3.20 MB)
Cultural Competency Program Information
Compliance requirements for health care providers
Humana and the state of Virginia require that all entities that participate with dual Medicare-Medicaid plans and Medicaid plans, including those contracted with subsidiaries, complete the following training materials:
- Cultural Competency Training
- Health, Safety and Welfare Education Training
- Medicaid Provider Training
- Humana Orientation Training
- Compliance and Fraud, Waste and Abuse Training