Submitting a claim electronically

Healthcare professionals and facilities can use the Availity Portal and electronic data interchange (EDI) services as no-cost solutions for submitting claims electronically. To register for the Availity Portal or to learn more about Availity claims solutions, visit Availity.com.

If submitting a claim to a clearinghouse, use the following payer IDs for Humana:

• Claims: 61101
• Encounters: 61102

Advanced claims editing

All EDI submissions to Humana pass through Availity. A process known as advanced claims editing (ACE) applies coding rules to a medical claim submitted through the Availity gateway via EDI before the claim enters Humana’s claim payment system. This enables a claim submitter to identify potential coding issues up front, and it reduces processing delays that can result from incomplete or inaccurate claim data.

For more information, review Electronic batch claims experience streamlined: Advanced claims editing (ACE).

Time frames to submit a claim

Please note the following time frames for submitting Medicare Advantage or commercial claims:

Medicare Advantage: Claims must be submitted within one year from the date of service or as stipulated in the provider agreement.

Commercial: Claims must be submitted within 90 days from the date of service if no other state-mandated or contractual definition applies.

If a claim is submitted in error to a carrier or agency other than Humana, the timely filing period begins on the date the provider was notified of the error by the other carrier or agency.

Checking claim status online

Healthcare professionals can check the status of a claim on the Availity Portal. Registration is required for access to the portal. Go to Availity.com .

To find out more, please review this flyer .

Assistance with claim submission

If your claim is rejected at the vendor level, please contact the vendor for assistance.

If you need further assistance with an electronic claim submission, please call your vendor's customer service help line.

Texas deficient claims

If you are a Texas-based healthcare provider, read this flyer to learn how to check a deficient claim online.

View deficient claims

To decrease administrative costs and improve cash flow, clinicians and facilities are encouraged to use electronic claim submission whenever possible.

If it is necessary to submit a paper claim, please use the addresses below. Keep in mind, however, that the claim or encounter mailing address on the member’s identification card is always the best to use.

Valid National Provider Identifiers (NPIs) are required on an electronic claim and strongly encouraged on a paper claim. If a paper claim does not have all necessary NPIs, it may be denied or be subject to delays in adjudication.

Paper claim and encounter submission addresses

Humana medical claims:

Humana Claims
P.O. Box 14601
Lexington, KY 40512-4601

HumanaDental® claims:

HumanaDental Claims
P.O. Box 14611
Lexington, KY 40512-4611

Humana encounters:

Humana Encounters
P.O. Box 14605
Lexington, KY 40512-4605

Claim overpayments:

Humana
P.O. Box 931655
Atlanta, GA 31193-1655

Time frames to submit a claim

Please note the following time frames for submitting Medicare Advantage or commercial claims:

Medicare Advantage: Claims must be submitted within one year from the date of service or as stipulated in the provider agreement.

Commercial: Claims must be submitted within 90 days from the date of service if no other state-mandated or contractual definition applies.

If a claim is submitted in error to a carrier or agency other than Humana, the timely filing period begins on the date the provider was notified of the error by the other carrier or agency.

Billing guidelines for submitting a roster bill on a paper claim

Humana reimburses for roster bills for select vaccinations. Healthcare providers should follow the billing guidelines below when submitting roster bills to Humana for those select vaccinations:

• Healthcare providers can submit multiple documents in a single large envelope.
• Documents may include information regarding multiple patients.
• Healthcare providers can submit CMS 1500 forms or UB04 forms with an attachment listing multiple patients receiving the same service. The claim form should have the words "see attachment" in the "Member ID" box.

Please send a roster bill to the following address:

Humana
Attn: Claims
P.O. Box 14601
Lexington, KY 40512-4601

Texas deficient claims

If you are a Texas-based physician or other healthcare provider, read this flyer to learn how to check a deficient claim online.

View deficient claims