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What's New
Here are our newest tools and resources available to our Providers. |
A New and More Detailed Look for Member Eligibility & Benefit Information
On July 11, 2008, Humana will implement changes to the Eligibility & Benefits screens in preparation to apply for Committee on Operating Rules for Information Exchange (CORE) certification. For Humana, the CORE Phase I has streamlined the way eligibility and benefits, as well as other health care administrative information, is exchanged electronically. This means Humana has improved the way providers and members view eligibility and benefits information on Humana.com.
CORE is an initiative created by CAQH, a nonprofit alliance of health plans, networks, and trade associations working to simplify healthcare administration.
To see how the Website is changing, view this presentation: NEW Eligibility Display
 (3.36 MB) Download PPT
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Additionally
Interview with Dr. Michael Roizen
Best-selling author Dr. Michael Roizen of the Cleveland Clinic visited Humana’s offices recently. Roizen, Humana’s medical advisor for consumer health, sat down for a few moments for an interview. Listen to his thoughts on wellness and “smart patients.”
 (4.1 MB) Download MP3
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View general, MSO/IPA/PHO and Humana Preferred terms and conditions for the commonwealth of Kentucky.
Texas-based providers can learn how to check their deficient claims online by clicking here.
Learn more about Humana's policy.
This capability allows a provider to bill for services at the "point of service." A fully adjudicated response is returned from Humana, detailing the total charge submitted, allowable charges, as well as the patient's responsibility.
Obtain more information about plans offered in your area.
Learn more about services that can benefit your patients with Humana plans.
Humana.com users can now use this Demo to help guide them through functionality on Humana.com.
Humana is pleased to introduce a new program created exclusively for Humana and Humana ChoiceCare Network participating providers that is designed to help reduce credit card transaction fee costs for your practice. Through this new program, created by a Humana and Chase Paymentech Solutions, LLC partnership, your practice can accept credit cards at significantly discounted processing rates.
Humana.com users will now find a more efficient and user-friendly website for their use. Information includes referral/authorization resources, network/market information, e-tools and resources, Humana.com training information and much more.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated that all providers use a standard unique identifier on all standard electronic transactions. The use of the National Provider Identifier (NPI) is mandated on all HIPAA-standard electronic transactions by May 23, 2007.
- Business Function Realignment - Humana.com Primary Access Administrators will now find it easier to give their associates access to secured business functionality. These functions within the “Administration” area are now listed in a more user friendly format.
- How to access and login to Secure Portal, Select Assign Web Access Rights in the Administration Panel
- How to link from Secure Portal to the Provider Resource Center – Humana.com users will now have the capability to access the Provider Resource Center from their secure menu, without logging out of the secure portal.
- How to Access: Login to the Secure Portal, the link will appear in the Information Center Panel
False Claims
It is a federal requirement that Medicaid-contracted medical providers and their employees adopt "Humana's Business Entity and Employee Education Policy about False Claims Recovery."
Humana Business Entity and Employee Education Policy about False Claims Recovery - Florida
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Humana Business Entity and Employee Education Policy about False Claims Recovery - Puerto Rico
(36 KB) Download PDF
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Humana Remittance Advice Code Descriptions
The attached document provides a comprehensive list of Humana's Remittance Advice Codes and Descriptions.
(486 KB) Download PDF
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Smart Summary
The SmartSummary statement is the industry’s first comprehensive and personal, consumer-focused health benefits budgeting, planning and reporting document. Humana members receive their SmartSummary statement quarterly. View a sample of what they receive.
(1.88 MB) Download PDF
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SmartSummary Rx
In a slightly different format and delivered on a monthly basis, SmartSummary Rx offers many of the same benefits of the SmartSummary statement to Humana's Medicare members.
(1.18 MB) Download PDF
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