2014 formularies

Hospitals Need to Note Important Reimbursement Information

Reimbursement of an inpatient claim depends on factors such as whether specific services were medically necessary, whether the inpatient admission itself was appropriate, and whether applicable authorization requirements, if any, were satisfied. When requirements for reimbursement of an inpatient claim have not been met, a hospital may be reimbursed for some services under other claim types. To be eligible for reimbursement for a Humana Medicare Advantage enrollee, the hospital must submit separate claims for emergency-related outpatient and post-inpatient-admission services, as provided in Humana’s Inpatient to Outpatient Rebilling claims payment policy.

This applies to scenarios outlined in the claims payment policy. For more information, please review the policy here by entering “Inpatient to Outpatient Rebilling” in the search box.

Questions may be directed to Humana provider customer service at 1-800-457-4708, Monday through Friday, 8 a.m. to 8 p.m. Eastern time.