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Join our network and find credentialing information.

Log in to Availity Essentials™ to access patient benefits, claims information and more.

Find tools and materials to support doing business with us.

Learn more about research and trends that impact your practice.

Find self-service info and phone numbers and update your provider data.

Review prior authorization lists for services, medications and submission guidance.

Prior authorization submission information

Professionally administered drugs prior authorization

Find appeals guidelines and payment policy information.

Learn how to submit claims and find coding guidance.

Find policies for procedures, devices and medications.

Review guidelines and health programs to support your patients and practice.

Find dental benefits, tools and resources.

Prior authorization for professionally administered drugs 

Locate state-specific resources for Humana Healthy Horizons® (Medicaid).

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Shop plans, learn about Medicare and explore member resources.

Search for in-network medical, vision, dental and pharmacy providers.

Claim coding and inquiry process guidelines

For detailed information about Humana’s claim payment inquiry process, review the claim payment inquiry process guide (300 KB).

The following links are intended to facilitate documentation and coding diagnoses and services that are provided to patients with Humana coverage:*

Atrial fibrillation coding guidelines

Cardiomyopathy coding guidelines

Cerebrovascular accident (CVA) coding guidelines

Chronic kidney disease (CKD) coding guidelines

Deep vein thrombosis (DVT) coding guidelines

Diabetes mellitus coding guidelines

Diseases of the respiratory system coding guidelines

Heart failure coding guidelines

Major depression/major depressive disorder coding guidelines

Mental health disorder coding guidelines

Mental health disorder (Dementia addendum) coding guidelines

Myocardial infarction coding guidelines

Neoplasms coding guidelines

Neoplasms (breast cancer addendum) coding guidelines

Neoplasms (prostate cancer addendum) coding guidelines

Obesity/body mass index (BMI) coding guidelines

Peripheral vascular disease (PVD) coding guidelines

Pressure injury coding guidelines

Rheumatoid arthritis (adult) coding guidelines

Seizures/seizure disorder/epilepsy coding guidelines

Sick sinus syndrome (SSS) coding guidelines

Substance use disorder coding guidelines

Vertebral fractures coding guidelines



*The external coding guidelines provided on this website are intended as general information only and are designed to communicate information about coding and documentation in an educational format. Humana is not providing or offering medical or legal advice, but rather, practical and useful information and tools in the area of clinical documentation and coding. Every reasonable effort has been taken to ensure that the educational information provided is accurate and useful. We make no claim, promise or guarantee of any kind about the accuracy, completeness or adequacy of the content for a specific claim, situation or provider office application and expressly disclaim liability for errors and omissions in such content. No guarantee is provided that the use of this information will prevent differences of opinion or disputes with Medicare, Medicaid or other third-party payers as to the amount that will be paid to providers. As diagnostic codes change annually, you should reference the current version of published coding guidelines and/or recommendations from nationally recognized coding organizations for the most detailed and up-to-date information. No copy or use beyond the online access or internal use of this presentation by an individual provider office should occur without express permission of Humana.

Humana guidelines and best practices

Diagnosis coding documentation