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Serving and Supporting Providers, Humana is making real-time updates to our processes in response to COVID-19 so we can better serve and support our providers.
Claims Processing and Payments:
We have made changes to benefits and temporarily reduced administrative requirements to streamline processes and increase access to care.
Suspension of pre- and post-paid claim reviews:
Effective April 1, Humana will suspend all medical records requests for pre-and post-paid claim review processes for individual and Group Medicare Advantage, Commercial Group, and Medicaid. This suspension applies to all professional and facility claims from in-network and out-of-network providers Humana will release any claims currently under medical record review as of April 1 and issue payment to providers Although medical record claim reviews are suspended, we may request medical records retrospectively once the suspension is lifted We will continue to reassess the need for this suspension as the COVID-19 public health crisis evolves and circumstances change
Utilization Management Suspension of most pre-authorization requirements and referrals:
Previously, Humana suspended pre-authorization requirements on COVID-related diagnoses, excluding post-discharge, for both participating/in-network and non-participating/out-of-network providers Humana is expanding this suspension to include suspending nearly all pre-authorization requirements for participating/in-network providers. This applies to inpatient (acute and post-acute), outpatient, and all referrals for Humana’s individual and Group Medicare Advantage, Commercial Group, and Medicaid plans This continues to apply to both participating/in-network and non-participating /out-of-network providers when the member has a COVID-related diagnosis Otherwise, non-par/out-of-network providers must continue to follow referral requirements and submit authorization requests per Humana’s policy Drug/pharmacy related requests (Commercial, Part D and Part B), Transplant, and Genetics-related pre-authorization requirements will continue to be in effect.
In the interest of our members’ health and to help support future transitions of care, please continue to submit a notification as normal when your Humana-covered patients are admitted to the hospital, even when authorization is not required. The notification will allow us to track patients’ progress through the healthcare delivery system and provide assistance in real time. You will receive automatic approval when you submit the notification.
Finally, given that many providers are postponing elective or non-emergent services, Humana is extending previously approved authorizations to a 90 day approval timeframe, except for home health authorizations, which are being extended for 60 days.
Two call centers are at reduced capacity due to shelter in place requirements in specific geographies, and this may result in longer hold times than usual. We encourage providers to leverage self-service tools where possible through Availity.com.
The Humana credentialing team is applying any federal or state emergency regulations for COVID-19 including such items as: Waiving site visit requirements, Approving licensed providers to practice outside of their licensed state, Placing a hold on the decredentialing process (only for providers missing information).
These are temporary credentialing changes based on the emergency regulations. The normal procedures will apply when the emergency regulations are lifted. If there are additional ways we can support you and your healthcare organization, please call our Provider Relations department at 1-866-427-7478 or contact your Humana representative.
Durable Medical Equipment Delivery (DME):
To support social distancing, DME vendors should waive the signature-at-delivery requirement for DME-delivered to members with a COVID-19-related diagnosis.
COVID-19 Resouces From Humana