Providers who care for PathWays members, with coverage through Humana Healthy Horizons^® in Indiana can submit paper claims through the mail or electronic claims through their secure Availity Essentials™ account.

Paper claims should be mailed to Humana Claims, P.O. Box 14169, Lexington, KY 40512 4169

For electronic claims, sign in to your Availity Essentials account and select the Humana Indiana Medicaid payer ID 61101 from the Payer drop-down menu before submitting.

Claims processing timelines vary, based on the way they are submitted to Humana. Electronic HCBS claims submissions will be processed within 7 business days of the receipt of the claim. All non-HCBS claims submitted electronically will be processed within 21 calendar days of the receipt of the claim. Paper claims may take up to 30 days to process.

Quick reference guide for answers to common questions about claims processing

Working with Humana

Below we include information about authorizations, electronic claims submissions, payment integrity, disputes processes and more.

If you have any questions at all, or need other information, contact Provider Services at 866-274-5888.

Get paid faster

Have your Humana claims payments deposited automatically into your bank account with electronic funds transfer (EFT) and electronic remittance advice (ERA). You will sign up through  Availity Essentials  to do this. Humana will make sure to process electronically submitted clean claims or Medicare crossover claims within 7 business days, and within 30 calendar days for clean paper claim submissions. It is important that required elements are completely filled out, or this may delay the processing of your claim. If you have any claims or billing questions, please reach out to us any time at  INMedicaidClaimsResearch@humana.com .

Out-of-network claims

Most services rendered by an out-of-network provider require prior authorization, with some exceptions such as open access or urgent/emergency services. Please check PRIOR AUTH LIST to determine if services require a prior authorization or call Provider Services at 866-274-5888.

If you would like to become a participating provider with Humana, please reach out to us in one of the following emails, as applicable:

• Medical services:  INProviderUpdates@humana.com
• Behavioral health services:  INBHMedicaid@humana.com
• Long-term services and supports:  LTSSContracting@humana.com

Payment integrity and disputes

At Humana, we strive to offer our members high-quality healthcare at affordable rates. To achieve this goal, the Humana Provider Payment Integrity (PPI) department reviews claims payments for accuracy and requests refunds if claims are overpaid or paid in error.

Common reasons for overpayment include:

• An issue regarding the coordination of member benefits
• Duplicate payments
• Fraud, waste and abuse detection
• Incorrect provider reimbursement
• Medical coding reviews
• Medical record reviews
• Member plan termination
• Subrogation

Managing overpayments online

The overpayment application on the Availity Essentials portal can help you manage overpayments. You can:

• Manage overpayment documentation and maintain case histories electronically
• Reduce overpayment resolution time by managing overpayment requests from multiple payers
• Request more information about or dispute an overpayment request.
• Sign up for notifications when you have an overpayment
• View overpayment inventory in real-time

The overpayment application is in the Availity Essentials portal under the claims and payments section. If you do not see the application, ask your organization’s Availity administrator to grant you the “Claim Status” role.

Refund checks for overpayments can be mailed to:
Humana Healthcare Plans
P.O. Box 931655
Atlanta, GA 31193-1655

Informal claim dispute process:

Providers can submit requests for informal claim disputes via written correspondence:

• Through  Availity Essentials , our secure provider portal
• By mail:
  
  Humana Healthy Horizons in Indiana
  Attn: Informal Dispute
  PO Box 14169
  Lexington, KY 40512-4169
  
  
• Via email:  INMedicaidClaimsResearch@humana.com

 

Informal claim disputes must be received within 60 calendar days of the notice of Humana’s determination. For more information, contact Provider Services at 866-274-5888.

Provider claim dispute process

Formal dispute process:

If additional review is necessary, you can submit a formal dispute to Humana in writing. Humana’s Provider Relations department reviews all formal dispute requests.

Formal disputes should be mailed to:

Humana Healthy Horizons in Indiana
Attn: Formal Dispute
201 North Illinois Street Suite 1200
Indianapolis, IN 46204

Or submitted via email:  IndianaFormalDispute@Humana.com .

These requests must be received within 60 calendar days, after the conclusion of the 30 calendar day informal dispute process.

For more information about Humana’s formal dispute process, contact Provider Services at 866-274-5888.

Emergency room services

Humana does not require authorization for Emergency Room Services. We also do not reduce payments to treatment room charges, thus eliminating the need for any autopay lists or layperson reviews. If you have any specific questions or concerns pertaining to this, please contact your Provider Education and Outreach Representative.