Whether you’re new to our network, or simply need a refresher, these self-paced guides were created to make working with us easier. Explore the presentations or download the tip sheet for a quick overview.
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Tools and Resources for Physicians and Other Healthcare Providers
Learn about Humana’s inventory of useful tools and resources, which can simplify your claims-related and other interactions with Humana. Printable resource guides are included.
Updated: Mar 2024 Runtime: 9:40
Anatomical Modifiers
Learn about Humana’s policy requiring the use of anatomical modifiers when submitting claims for your patients with Humana Medicare Advantage, commercial and select Medicaid plans.
Updated: Feb 2025 Runtime: 15:09
Application of Medicare NCD/LCD Guidelines
Learn how Humana administers Medicare national coverage determinations (NCDs), local coverage determinations (LCDs) and related articles for Medicare Advantage plans.
Updated: Mar 2024 Runtime: 14:00
Authorizations - Avoid Claim Denials
Learn about the importance of obtaining an authorization or preauthorization, when required; about options for obtaining an authorization or preauthorization; and about the appropriate steps to take when an authorization- or preauthorization-related claim is denied. The information in this presentation applies to claims submitted for your patients with Humana Medicare Advantage and commercial plans.
Updated: Jun 2024 Runtime: 19:25
Availity Editing Services (AES)
Learn about the Availity Editing Services (AES) tool and its benefits for claim submission. This information applies to professional and facility claims submitted for your patients with commercial, Humana Medicare Advantage (MA) and select Medicaid plans.
Updated: Apr 2024 Runtime: 14:21
Availity Essentials Overpayments Tool
Learn about the Availity Essentials Overpayments tool, where to find the tool and the benefits of using the tool to manage overpayments identified by Humana. The information applies to claims submitted for your patients with Humana Medicare Advantage (MA), commercial and Medicaid plans.
Updated: Oct 2024 Runtime: 9:14
Bilateral Services and Modifier 50
Learn about Humana’s policies for reporting bilateral services and the use of modifier 50 for services provided to Medicare Advantage and commercial members.
Updated: May 2024 Runtime: 10:27
Chronic Care Management and Principal Care Management Services
Learn about Humana’s policy for coverage of chronic care management, complex chronic care management and principal care management services when submitting claims for your patients with Humana Medicare Advantage and Medicaid plans.
Updated: Dec 2023 Runtime: 15:26
Claim Disputes and Corrected Claims
Learn about Humana’s processes for medical claim disputes and corrected claims. This information pertains to professional and facility claims submitted for your patients with Humana Medicare Advantage and commercial plans.
Updated: Apr 2024 Runtime: 16:47
Claim Processing Edit Notifications
Learn about the claim processing edits page and how to access and use claim code-editing information located there as a resource for understanding how Humana processes claims. This presentation applies to claims submitted for services for your patients with Humana Medicare Advantage and commercial plans.
Updated: Feb 2024 Runtime: 8:35
Continuous Glucose Monitors (CGMs)
Learn about continuous glucose monitors (CGMs) and guidance around the coverage criteria and appropriate billing. The information in this presentation applies to claims submitted for your patients with Humana Medicare Advantage plans.
Updated: Dec 2024 Runtime: 12:42
Drug Testing and Codes
Learn about Humana’s policies on drug testing for patients with Humana Medicare Advantage, commercial and select Medicaid plans. This is an updated version of a previous presentation.
Updated: Dec 2023 Runtime: 15:59
Durable Medical Equipment - Guidance Highlights
Learn about Humana’s general guidance related to durable medical equipment, prosthetics, orthotics, and supplies, or DME. This presentation applies to claims submitted for services for your patients with Humana Medicare Advantage and commercial plans.
Updated: Feb 2024 Runtime: 9:47
Emergency Department E/M Reimbursement
Learn about Humana’s policy for reimbursing in-network facility claims for evaluation and management services rendered to patients with Humana Medicare Advantage plans, and for reimbursing claims submitted by all facilities, in-network and out-of-network, for patients with commercial plans.
Updated: Dec 2024 Runtime: 16:20
Florida Dual-Eligible and Crossover Claims
Learn about managing your claims for dual-eligible patients in Florida with both Medicare and Humana Healthy Horizons® plans. This information applies to claims submitted for your dual-eligible patients in Florida with Medicare (Original or Medicare Advantage) and Humana Healthy Horizons plans.
Updated: Dec 2024 Runtime: 9:46
Genetic Testing - Billing and Coding for Medical and Laboratory Providers
Learn about Humana’s billing expectations for coverable medically necessary genetic testing and how Humana will adjudicate and reimburse claims for those services. This information applies to claims submitted for your patients with Humana Medicare Advantage, select commercial and select Medicaid plans.
Updated: Jul 2024 Runtime: 26:18
Home Health Billing
Learn about Humana’s guidelines for submitting claims for home health services for your patients with Medicare Advantage and commercial plans.
Updated: Dec 2023 Runtime: 12:54
Humana's Approach to Code Editing
Learn about Humana’s approach to code editing for claims for your patients with Humana Medicare Advantage, commercial and Medicaid plans.
Updated: Dec 2024 Runtime: 11:47
Humana's Maximum Unit Values
Learn about Humana’s approach to maximum unit values for claims submitted for your patients with Humana Medicare Advantage, commercial and Medicaid plans.
Updated: Jul 2024 Runtime: 12:13
Medical Claim Appeals
Learn about Humana’s policy on medical claim appeals for your patients with Humana Medicare Advantage, commercial and Medicaid plans.
Updated: Apr 2024 Runtime: 18:58
Medical Record Management (MRM) Tool - Benefits of Online Submission
Learn about the importance of medical record reviews and the benefits of submitting requested medical records online. The information applies to claims submitted for your patients with Humana Medicare Advantage, commercial and Medicaid plans.
Updated: Jan 2024 Runtime: 10:53
Medical Record Requests for Specialized Laboratory Services
Learn about Humana’s expectations and requirements for medical record requests for specialized laboratory services (genetic testing, urine drug testing, infectious agent molecular testing and cytogenetic/pathology services). This information applies to claims submitted for your patients with Humana Medicare Advantage (MA), commercial and select Medicaid plans.
Updated: Jun 2024 Runtime: 16:32
Medicare Advantage Preventive Visits
Learn about Humana’s policies for preventive visits for your patients with Humana Medicare Advantage plans. Topics covered include the Initial Preventive Physical Examination (IPPE), Annual Wellness Visit, Annual Preventive Physical Exam and Well Woman Exam. This presentation includes a printable tip sheet.
Updated: Jul 2024 Runtime: 22:12
Medicare Advantage Preventive Visits - FQHC
Learn about Humana’s policies for preventive visits rendered in federally qualified health centers (FQHCs) for your patients with Humana Medicare Advantage plans. Topics covered include the Initial Preventive Physical Examination (IPPE), Annual Wellness Visit, Annual Preventive Physical Exam and Well Woman Exam.
Updated: Jul 2024 Runtime: 24:42
Medicare Advantage Preventive Visits - RHC
Learn about Humana’s policies for preventive visits rendered in a rural health clinic (RHCs) for your patients with Humana Medicare Advantage plans. Topics covered include the Initial Preventive Physical Examination (IPPE), Annual Wellness Visit, Annual Preventive Physical Exam and Well Woman Exam.
Updated: Jul 2024 Runtime: 22:51
Modifier 24
Learn about Humana’s policy on the use of modifier 24 when submitting claims for your patients with Humana Medicare Advantage and commercial plans.
Updated: Feb 2024 Runtime: 11:28
Modifier 25
Learn about Humana’s policy on the use of modifier 25 when submitting claims for your patients with Humana Medicare Advantage, commercial and select Medicaid plans.
Updated: Feb 2024 Runtime: 12:30
Modifiers 59 and X{EPSU}
Learn about Humana’s policy on the use of Modifier 59 and the X{EPSU} modifiers. This information applies to claims submitted for your patients with Humana Medicare Advantage, commercial and Medicaid plans..
Updated: Jan 2024 Runtime: 13:58
Modifiers 76 and 77
Learn about Humana’s policy on the use of modifiers 76 and 77 to indicate that a service is a repeat procedure. This presentation applies to claims submitted for services for your patients with Humana Medicare Advantage, commercial and select Medicaid plans.
Updated: Jan 2024 Runtime: 10:06
Multiple Evaluation and Management (E/M) Services
Learn about Humana’s policy for reimbursement of multiple E/M services for physicians and other professional providers submitting claims for patients with Humana Medicare Advantage, commercial and select Medicaid plans.
Updated: Feb 2024 Runtime: 13:04
Mutually Exclusive Diagnosis Combinations: ICD-10 Excludes 1 Notes
Learn about Humana’s process for services billed with mutually exclusive ICD-10 code combinations. This information applies to professional claims submitted for your patients with commercial, Humana Medicare Advantage (MA) and select Medicaid plans.
Updated: May 2024 Runtime: 9:01
Notifying CMS of ESRD Status
Learn about Humana's guidance for reporting end-stage renal disease for your patients with Humana Medicare Advantage, commercial and Medicaid plans.
Updated: Dec 2023 Runtime: 10:44
Procedure-to-Procedure Code Editing
Learn about Humana’s code editing for incidental, mutually exclusive and unbundled code combinations. This information applies to claims for your patients with Humana Medicare Advantage, commercial or select Medicaid plans.
Updated: Apr 2024 Runtime: 14:42
Professional Component and Technical Component (PC/TC)
Learn about Humana’s policies for proper reporting and reimbursement of the professional and technical components of a service for your patients with Humana Medicare Advantage, commercial and select Medicaid plans.
Updated: Apr 2024 Runtime: 12:57
Referrals - Avoid Claim Denials
Learn about the importance of obtaining a referral for a service, medication or durable medical equipment (DME) item when required, and the options for obtaining those referrals. The information in this presentation applies to claims submitted for your patients with Humana Medicare Advantage and commercial plans.
Updated: Sep 2024 Runtime: 15:10
Referrals vs Authorizations
Learn about a referral and an authorization and the difference between them. This information applies to referrals and authorizations submitted for your patients with Humana Medicare Advantage (MA) and commercial plans.
Updated: Apr 2024 Runtime: 15:22
Reporting Diagnosis Codes in the Primary Position
Learn about reporting primary diagnosis codes and how to avoid some common errors when reporting those codes. This information applies to claims submitted for your patients with Humana Medicare Advantage, commercial and Medicaid plans.
Updated: Oct 2023 Runtime: 21:05
Understanding an Explanation of Remittance (EOR)
Understand your Humana EOR for patients with Humana Medicare Advantage, commercial and Medicaid plans.
Updated: Jun 2024 Runtime: 18:39
Use of Diagnosis Pointers
Learn about Humana’s approach to diagnosis pointers for claims submitted for your patients with Humana Medicare Advantage, commercial and Medicaid plans.
Updated: Jul 2024 Runtime: 9:50
Use of Non-Specific Procedure Codes
Learn about Humana’s requirements for submission of non-specific, or unlisted, CPT or HCPCS codes for your patients with Humana Medicare Advantage, commercial and select Medicaid plans.
Updated: Apr 2024 Runtime: 14:22
Using Humana Resources to Address Patient Concerns - Related to Medicare Advantage Preventive Services
Learn about Humana’s coverage of Medicare Advantage (MA) preventive screening services and Humana resources available to address patient concerns related to those preventive visits. This information applies to services rendered for your patients with Humana MA plans.
Updated: Dec 2023 Runtime: 13:57