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Making It Easier

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Provider Portal: Joining Humana’s Network

Released: October 2024. This presentation will provide guidance about signing into the provider portal and the self-service steps required to join the Humana network. This information applies Humana Healthy Horizons® in Indiana plans. Runtime 8:42

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Referrals - Avoid Claim Denials


Updated: September 2024. 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. This presentation includes a printable tip sheet. Runtime: 15:10

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Medicare Advantage Preventive Visits

Updated: July 2024. 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. Runtime: 22:12

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Medicare Advantage Preventive Visits – FQHC


Updated: July 2024. 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. This presentation includes a printable tip sheet. Runtime: 24:42

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Medicare Advantage Preventive Visits – RHC    


Updated: July 2024. 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. This presentation includes a printable tip sheet. Runtime: 22:51

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Genetic Testing - Billing and Coding for Medical and Laboratory Providers

Updated: July 2024. 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. This presentation includes a printable tip sheet. Runtime: 26:18


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Humana’s Maximum Unit Values

Updated: July 2024. Learn about Humana’s approach to maximum unit values for claims submitted for your patients with Humana Medicare Advantage, commercial and Medicaid plans. This presentation includes a printable tip sheet. Runtime: 12:13

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Use of Diagnosis Pointers

Updated: July 2024. Learn about Humana’s approach to diagnosis pointers for claims submitted for your patients with Humana Medicare Advantage, commercial and Medicaid plans. This presentation includes a printable tip sheet. Runtime: 9:50

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Authorizations - Avoid Claim Denials

Updated: June 2024. 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. This presentation includes a printable tip sheet. Runtime: 19:25

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Medical Record Requests for Specialized Laboratory Services

Updated: June 2024. 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. The presentation includes a printable tip sheet. Runtime: 16:32

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Understanding an Explanation of Remittance (EOR)

Updated: June 2024. Understand your Humana EOR for patients with Humana Medicare Advantage, commercial and Medicaid plans. This presentation includes a printable tip sheet. Runtime: 18:39

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Bilateral Services and Modifier 50

Updated: May 2024. Learn about Humana’s policies for reporting bilateral services and the use of modifier 50 for services provided to Medicare Advantage and commercial members. This presentation includes a printable tip sheet. Runtime: 10:27

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Mutually Exclusive Diagnosis Combinations: ICD-10 Excludes 1 Notes

Updated: May 2024. 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. The presentation includes a printable tip sheet. Runtime: 9:01

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Professional Component and Technical Component (PC/TC)

Updated: April 2024. 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. This presentation includes a printable tip sheet. Runtime: 12:57

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Procedure-to-Procedure Code Editing

Updated: April 2024. 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. This presentation includes a printable tip sheet. Runtime: 14:42

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Use of Non-Specific Procedure Codes

Updated: April 2024. 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. This presentation includes a printable tip sheet. Runtime: 14:22

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Availity Editing Services (AES)

Updated: April 2024. 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. The presentation includes a printable tip sheet. Runtime: 14:21

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Referrals vs Authorizations

Updated: April 2024. 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. This presentation includes a printable tip sheet. Runtime: 15:22

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Medical Claim Appeals

Updated: April 2024. Learn about Humana’s policy on medical claim appeals for your patients with Humana Medicare Advantage, commercial and Medicaid plans. This presentation includes a printable tip sheet. Runtime: 18:58

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Claim Disputes and Corrected Claims

Updated: April 2024. 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. This presentation includes a printable tip sheet. Runtime: 16:47

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Application of Medicare NCD/LCD Guidelines

Updated: March 2024. Learn how Humana administers Medicare national coverage determinations (NCDs), local coverage determinations (LCDs) and related articles for Medicare Advantage plans. This presentation includes a printable tip sheet. Runtime 14:00

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Multiple Evaluation and Management (E/M) Services

Updated: February 2024. 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. This presentation includes a printable tip sheet. Runtime: 13:04

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Modifier 25

Updated: February 2024. 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. This presentation includes a printable tip sheet. Runtime: 12:30

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Modifiers 96 and 97 (Habilitative and Rehabilitative Services)

Updated: February 2024. Learn about Humana’s policy requiring the use of modifiers 96 and 97 (habilitative and rehabilitative services) when submitting professional and institutional claims for your patients covered by Humana commercial plans with essential health benefits. This presentation includes a printable tip sheet. Runtime: 15:51

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Modifier 24

Updated: February 2024. Learn about Humana’s policy on the use of modifier 24 when submitting claims for your patients with Humana Medicare Advantage and commercial plans. This presentation includes a printable tip sheet. Runtime: 11:28

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Durable Medical Equipment – Guidance Highlights

Updated: February 2024. 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. This presentation includes a printable tip sheet. Runtime: 9:47

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Claim Processing Edit Notifications

Updated: February 2024. 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. This presentation includes a printable tip sheet. Runtime: 8:35

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Modifiers 59 and X{EPSU}

Updated: January 2024. 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. This presentation includes a printable tip sheet. Runtime: 13:58

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Modifiers 76 and 77

Updated: January 2024. 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. This presentation includes a printable tip sheet. Runtime: 10:06

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Medical Record Management (MRM) Tool – Benefits of Online Submission

Updated: January 2024. 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. This presentation includes a printable tip sheet. Runtime: 10:53

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Home Health Billing

Updated: December 2023. Learn about Humana’s guidelines for submitting claims for home health services for your patients with Medicare Advantage and commercial plans. This presentation includes a printable tip sheet. Runtime 12:54

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Chronic Care Management and Principal Care Management Services

Updated: December 2023. 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. This presentation includes a printable tip sheet. Runtime: 15:26

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Drug Testing and Codes

Updated: December 2023. 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. This presentation includes a printable tip sheet. Runtime: 15:59

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Using Humana Resources to Address Patient Concerns - Related to Medicare Advantage Preventive Services

Updated: December 2023. 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. This presentation includes a printable tip sheet. Runtime: 13:57

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Notifying CMS of ESRD Status

Updated: December 2023. Learn about Humana's guidance for reporting end-stage renal disease for your patients with Humana Medicare Advantage, commercial and Medicaid plans.This presentation includes a printable tip sheet. Runtime: 10:44

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Anatomical Modifiers

Updated: November 2023. 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. This presentation includes a printable tip sheet. Runtime: 15:09

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Reporting Diagnosis Codes in the Primary Position

Updated: October 2023. 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. This presentation includes a printable tip sheet. Runtime: 21:05

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Billing Hospice Services for VBID Demonstration Plans (2024)

Updated: October 2023. Learn about Humana’s requirements for submitting claims for hospice services provided as part of a value-based insurance design (VBID) demonstration plan. This information applies to claims submitted for your patients with Humana Medicare Advantage in Colorado, Florida, Georgia, Kentucky, Ohio, Virginia and Wisconsin. This presentation includes a printable tip sheet. Runtime: 17:03

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Humana’s Approach to Code Editing

Updated: October 2023. Learn about Humana’s approach to code editing for claims for your patients with Humana Medicare Advantage, commercial and Medicaid plans. This presentation includes a printable overview. Runtime: 12:18

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Continuous Glucose Monitors (CGMs)

Released: September 2023. 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. This presentation includes a printable tip sheet. Runtime: 12:42

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Emergency Department E/M Reimbursement

Updated: October 2023.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. This presentation includes a printable tip sheet. Runtime: 16:20

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Florida Dual-Eligible and Crossover Claims

Updated: October 2023. 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. This presentation includes a printable tip sheet. Runtime 9:43

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Disclaimer: The information in these presentations is general and does not represent individual member benefits, coverage or payment determinations made by Humana; nor does it supersede any determination made by Humana. It does not guarantee claim payment and should not be used as legal advice or a legal opinion. As claims policies and guidelines change, the information in these presentations may be updated to reflect those changes. For Humana member claim or benefit information, please call the number on the back of the member’s ID card.

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