During a 2016 review of benefits and claims, we discovered many basic radiology claims were not being paid as outlined in Humana Medicare members’ Evidence of Coverage (EOC). Humana‘s benefit intent is to apply a member copayment for all basic radiology claims, when applicable; however, claims for basic radiology services that did not include an evaluation and management (E&M) CPT code were being paid incorrectly at 100 percent with no member responsibility.
Effective Jan. 1, 2017, Humana began processing all basic radiology claims as communicated in the EOC. Now, patients with Humana Medicare coverage need to pay a copayment for basic radiology services, when applicable, regardless of whether an E&M code is present on the claim.
Physicians and other health care professionals can determine the copayment amount to collect from patients with Humana Medicare coverage by conducting a benefits check on Availity.com (registration required), Humana.com (registration required) or by calling Humana customer service at 1-800-457-4708, Monday through Friday, from 8 a.m. to 8 p.m. Eastern time.
Questions about this update can be directed to Humana customer service at 1-800-457-4708.