Online Tools, Presentations, Webinars Provide Important Tips to Physicians, Staff

Online tools

Humana adopts clinical practice guidelines based on guidance from national organizations generally considered experts in their fields. Humana's YourPractice features updates to these clinical practice guidelines as well as newly adopted guidelines. Humana intends to provide timely information about evidence-based best practices for patient care and to help improve quality measures and Stars scores. While many guidelines are updated annually, others may not change for several years. Humana encourages physicians and other practitioners to look for these clinical practice guideline notifications in Humana's YourPractice. Medical and behavioral health clinical practice guidelines are available here.

New and revised pharmacy and medical coverage policies

Humana's medical and pharmacy coverage policies are based on evidence published in peer-reviewed medical literature, technology assessments obtained from independent medical research organizations, evidence-based consensus statements and evidence-based guidelines from nationally recognized professional health care organizations.

Information about medical and pharmacy coverage policies can be found at by selecting "Medical and Pharmacy Coverage Policies" under "Resources." Medical and pharmacy coverage policies can be reviewed by name or revision date. Users may also search for a particular policy using the search box. More detailed information may be found by reviewing "How to Read a Medical Coverage Policy" and "Understanding the Medical Coverage Policy Development Process."

Below are the new and revised policies:

New pharmacy coverage policies

  • Auvi‐Q (epinephrine injection) Lyrica (pregabalin)
  • Belbuca (buprenorphine) buccal film
  • Cotellic (cobimetinib)
  • Darzalex (daratumumab)
  • Imlygic (talimogene laherparepvec)
  • Kanuma (sebelipase alfa)
  • Lyrica (pregabalin) -- Medicaid
  • Nuedexta (dextromethorphan and quinidine)
  • Onivyde (liposomal irinotecan)
  • Viberzi (eluxadoline)
  • Veltassa (patiromer)
  • Yondelis (trabectedin)

Pharmacy coverage policies with significant revisions

No pharmacy coverage policies with significant revisions

New medical coverage policies

  • Bunion surgical treatments
  • Genetic testing
  • Hammertoe surgical treatments
  • Hip, knee and shoulder arthroscopic surgeries
  • Vocal cord insufficiency treatments

Medical coverage policies with significant revisions

  • Bariatric surgery
  • Benign prostatic hyperplasia (BPH) treatments
  • Bone graft substitutes
  • Cardiac monitoring devices
  • Chest wall deformities (pectus excavatum/carinatum and poland syndrome) treatments
  • Cryoablation
  • Durable medical equipment (DME)
  • Genetic testing for breast and/or ovarian cancer susceptibility
  • Genetic testing for cancer susceptibility
  • Genetic testing for colorectal cancer susceptibility
  • Inhaled nitric oxide
  • Noninvasive prenatal screening
  • Noninvasive tests for hepatic fibrosis
  • Pharmacogenomics and companion diagnostics
  • Reduction mammoplasty
  • Spinal fusion surgery
  • Tumor markers for diagnosis and monitoring of cancer
  • Urinary and fecal incontinence treatments
  • Varicose vein treatments

Medical coverage policies with significant revisions

  • Thermal capsular shrinkage (thermal capsulorrhaphy)

Online information makes it easier to do business with Humana

Humana's "Education on Demand" tool provides physicians, other practitioners and their office staff with quick, easy-to-understand information on topics that should simplify doing business with Humana.

To access this tool, health care providers may choose: If a computer with a sound card is not available or if the computer is not configured for streaming audio, the presentations may be accessed via telephone while viewing the slides on screen. To begin the telephone playback process, health care providers should follow these steps:

  • Click on the question mark in the bottom right corner
  • Select "Player Settings" from the pop-up box
  • Check "Use telephone playback with standard player"
  • Click the "Submit" button
  • A window will open displaying the telephone number and access code needed to hear the audio presentation

Available topics are as follows:

  • Commercial Risk Adjustment
  • HumanaAccessSM Visa Card
  • Humana Member Summary
  • HumanaVitality®
  • Making It Easier for Health Care Providers
  • Special Needs Plans (SNPs)
  • Texas Deficiency Tool
  • Working with Humana
  • ConsultTM Online
  • SmartSummary® Rx

Humana’s claims education page includes educational tools that help health care providers better understand Humana’s claims policies and processes. To access the tool, physicians and health care providers can visit

The page, which will be updated with new content each month, has brief education-on-demand computer-based presentations that include a printable tip sheet with the most important information about each topic. Current topics include:

  • Proper use of anatomical modifiers
  • Humana’s approach to code editing
  • Drug testing and codes
  • Humana’s approach to National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs)
  • Medicare preventive services
  • Modifier 24
  • Modifier 25
  • Modifiers 59 and X {EPSU}
  • Procedure-to-procedure code editing

The presentations can be accessed around the clock.

Webinars provide interactive learning overview

Health care providers who want to learn more about how they can save time, increase efficiency and help improve the productivity of their practice should plan to attend this introductory webinar. These sessions for office staff last between 45 minutes and one hour. overview topics

  • How to navigate’s public site
  • How to access member eligibility and benefit information
  • How to submit and check the status of a referral and/or authorizations
  • How to use Humana’s claims tools and remittance inquiry
  • How to register for ERA/EFT
  • How to view fee schedules
  • How to use the Medical Record Management tool

Available dates:

  • Thursday, March 10 at 2 p.m. Eastern time
  • Tuesday, April 5 at 11 a.m. Eastern time
  • Thursday, May 2 at 2 p.m. Eastern time
  • Tuesday, June 7 at 11 a.m. Eastern time

How to register

To register, visit

Confirmation and instructions on how to access the online webinar will be sent via email within 48 hours of the request.