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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.

Care Decision Insights

Independent research supports the premise that certain specialists consistently achieve improved clinical outcomes and higher quality of care with lower costs.1,2  Humana’s Care Decision Insights can help you identify those specialists, so that you can determine the best referral opportunities for your patients who need specialist care.

Using sophisticated claim analysis, Care Decision Insights provides profiles of specialist groups based on their effectiveness and efficiency, as well as referral pattern information. Specialists are evaluated on clinical quality measures that assess the effectiveness of treatment Humana-covered patients received, while efficiency is determined by comparing the cost of treatment Humana-covered patients received to treatment provided by similar doctors. The evaluation process for both is the same as for Care Highlight™. (For more information about Care Highlight, contact your Humana representative or visit Humana.com/CareHighlight.)

Care Decision Insights data can reassure you that the specialist who will see your patient next not only is in our network, but also is recognized for delivering quality care and improved patient outcomes.

If you are a specialist:

You will get an in-depth look at your effectiveness and efficiency performance measures, as determined by claim data. You also will see site-of-service referral information that could help you identify which in-network facilities might be the right fit for your patients.

To learn more

For more information about Care Decision Insights, contact your Humana representative.



        Katherine Baicker and Amitabh Chandra, "The Productivity of Physician Specialization; Evidence from the Medicare Program," accessed April 2021.

        Centers for Medicare & Medicaid Services. "Medicare Provider Utilization and Payment Data: Physician and Other Supplier," accessed April 2021.    



If you are a referring physician:

Sources

Patient care