Claims for Medicare-eligible Commercial Members Affected by Payment Policy

Anatomical Modifiers

A Humana payment policy may affect physicians and health care providers who provide services for commercial members who meet the following criteria:

  • They are eligible for Medicare Part B
  • They have chosen not to enroll in Medicare Part B
  • They are members who would have Medicare as their primary payer. (Only those members are impacted. For more information on when Medicare is the primary payer please review the Who Pays First guidance from Medicare.gov.)

For these members’ services, the physician or health care provider will receive only the amount Humana would have paid as the secondary payer. The member will be responsible for the amount that Medicare would have paid.

For information about this policy, physicians and health care providers can click here for answers to frequently asked questions.