Review  Medicare claims submission information .

AI/AN providers can verify the reimbursement rate set by Indian Health Services (IHS) for professional services based on their area office. Humana's rates should reflect this for non-participating professional reimbursement.

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Services that apply AIR*:

• Inpatient hospital per diem rate 
  • Excludes physician/practitioner services
• Outpatient per visit rate (excluding Medicare)
  • Includes physician/practitioner services
  • Includes dental, optometry and other Medicaid allowable services
• Outpatient per visit rate (Medicare)
  • Excludes physician/practitioner services
• Medicare Part B inpatient ancillary per diem rate
  • Excludes physician/practitioner services

*All Inclusive Rates: For more information on AIRs, bundled payments and rates, visit  2024 Federal Register  and  Indian Health Service reimbursement rates .

Please note: Because of the higher cost of living in Alaska, separate rates are calculated for Alaska and the Lower 48 States.

When an IHCP provider accepts Medicare assignment (participating with Medicare), that does not mean they are also automatically participating in Humana Medicare Plans. This distinction is important because it can have impacts on claims, copays, deductibles, etc.

If a provider is participating with Humana, that provider cannot collect over their Medicare contract.

A provider claim that is part of a Medicare network, but not a Humana network, will be applied to the member non-participating benefits. This could possibly lead to a high member cost share and/or reduced reimbursement from Humana.

A provider claim that is part of Humana's network would be applied to a member’s in-network benefits. This would be a reduced or waived member cost share and/or greater chance of reimbursement from Humana.

Each Medicaid state is required to consult with tribes who have IHCP networks within it. The state incorporates approved processes into its State Plan Amendment (SPA). Each state works with IHCPs to establish processes. If an IHCP credentialing process is not in place, work with the state to include one or you will need to develop new standard operating procedures (SOPs).

This process should be annually updated with state. For more information, refer to this site for  CMS Native American Contacts .

AI/AN members have the choice to select a tribal provider regardless of network status. However, at this time, Humana is unable to update the member insurance card. Currently, no provider-related action is needed. Check back for more information. For additional questions, call the number on the back of the member’s insurance card. (Medicare/Medicaid)

Medicaid: Certain reservations do have clinics that have pharmacies. If a pharmacy is based on a reservation, it can establish and set formularies. Pharmacies are generally housed within an IHCP health system and may be in or out of our network. For example, in Oklahoma the IHCPs bill the state directly for all encounters in adherence to contract language. It is best to check with the state offering the services to be clear on IHCP network and billing processes.

For Medicare: Providers should follow standard procedures.

If the member is listed on the 834 state* file as an AI/AN member in the Humana pharmacy system, they are set up ('programmed') to receive prescriptions at a $0 copay at any International Nonproprietary Names (INN) pharmacy. An AI/AN receiving care at an IHCP may choose to use that IHCP pharmacy.

*This file is a federally mandated ASC X12 standard to provide member enrollment information, such as new enrollment.

There are no current identified differences between how VABs will be offered to tribal and non-tribal members. Traditional Healing benefits are unique services and need to be conducted with necessary respect to the services being rendered. For example, Oklahoma established a provider link to their Tribal Liaison to enhance benefit care and offer cultural acuity.  

Humana would direct the AI/AN member to a contracted state agency, most of these would come through the provider call center.

For example, in Oklahoma IHCP authorizations/prior authorizations stay with the state because the state is responsible for claim payment. The process to connect with the state will remain the same. The non-participating IHCP providers would follow the Managed Care Organization’s (MCO) existing authorization process.

Contact designated state program office(s) working with the AI/AN Medicaid and/or Medicare population. For more information, visit the  CMS Native-American contact list . 

Humana offers many languages through telephone translation services, including Spanish, Cherokee, Chickasaw and Choctaw. Humana is continuously working on opportunities to increase translation services.

An 834 file, issued to an MCO by a state will have a complete list of the IHCPs in that state. IHS area offices generally maintain a list of IHCP facilities within their service area. 

For Providers in OK, review the  OK provider directory