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

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.

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 Humana.com/provider 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

  • Addyi (flibanserin)
  • Buprenex (buprenorphine HCl solution for injection)
  • Buprenorphine-containing products (Bunavail, buprenorphine SL tablet, buprenorphine/naloxone SL tablet, Suboxone SL film, Zubsolv)
  • Cycloset (bromocriptine)
  • Denavir
  • Jadenu (deferasirox)
  • Luzu (luliconazole)
  • Oxandrolone
  • Oxaydo (oxycodone HCl)
  • Oxecta
  • Oxistat
  • Patanase (olopatadine)
  • Proton pump inhibitors
  • Synera (lidocaine and tetracaine)
  • Taclonex (calcipotriene and betamethasone dipropionate)
  • Technivie (ombitasvir, paritaprevir, ritonavir)
  • Veltin (clindamycin and tretinoin gel)
  • Xenical (orlistat)
  • Xerese
  • Zarxio (filgrastim-sndz)
  • Zecuity (sumatriptan iontophoretic transdermal system)
  • Zostavax (zoster vaccine – live)
  • Zovirax (acyclovir ointment)

Pharmacy coverage policies with significant revisions

  • No pharmacy coverage policies with significant revisions

New medical coverage policies

  • Transcatheter left atrial appendage closure

Medical coverage policies with significant revisions

  • Actinic keratosis treatments
  • Capsule endoscopy
  • Functional electrical stimulators (FES), diaphragmatic/phrenic nerve stimulation
  • Genetic testing for disease risk
  • Genetic testing for inherited thrombophilias
  • Intraocular lens (IOL) implants
  • Lung cancer Screening
  • Multianalyte assays with algorithmic analyses (MAAAs) for nonmalignant diseases
  • Pulmonary rehabilitation (outpatient)
  • Radiofrequency tumor ablation
  • Total ankle replacement

Retired medical coverage policies

  • No retired medical coverage policies

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: https://www.humana.com/provider/support/on-demand/. 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 Humana.com/healthcareproviderhowto.

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 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
  • Humana’s Approach to Code Editing
  • Drug Testing and Codes

The presentations can be accessed around the clock.

Webinars provide interactive learning

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.

Topics include the following:

  • How to navigate Humana.com’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, Jan. 7 at 2 p.m. Eastern time
  • Tuesday, Feb. 9 at 11 a.m. Eastern time
  • Thursday, March 10 at 2 p.m. Eastern time

How to register

To register, visit Humana.com/providerwebinars.

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