To ensure that Humana-covered patients are assigned to the physician they rely on most for healthcare, Humana now has a process that automatically moves patients currently enrolled in a Humana health maintenance organization (HMO) plan who are located in an open access market to an in-network primary care physician (PCP), based on their claims history.
Patients enrolled in an HMO plan in an open access market can visit any physician who is in-network, without a referral. This creates the potential for misalignments in attribution.
Physicians should note that patients with designated PCPs are not restricted from seeing other physicians for primary care. In the event that a Humana-covered patient disagrees with the PCP change made as a result of this process, he/she can call Humana customer service and change PCPs at any time.
For more information, physicians can contact their provider engagement associate.