Here’s some news you can use from Humana:
Peer-to-peer review changing: Effective Aug. 1, Humana Medicare Advantage health plans will no longer offer peer-to peer reviews after a medical necessity denial for an authorization request for medical services. Instead, a Humana representative will call the treating physician and offer to schedule a peer-to-peer review before Humana issues the denial. The physician can submit additional clinical information any time before the review. You can help avert denials by submitting all relevant medical records and pertinent information with your initial request.
More Tips From Humana
Humana Medicare supplement ID card explained: Humana Value Medicare Supplement Insurance Plan cards have the plan name at the top; the cards also say “HumanaDental Insurance Company” at the bottom. Don’t be confused: the Humana Value Medicare Supplement Plan is offered under HumanaDental Insurance. This is not a card for a Humana dental plan.
Use these tools on the Availity portal:
- Look for a new medical records management application under “Payer Spaces” on the Availity provider portal. With this application, you can review a list of records requests from Humana filtered by tax ID number; upload to Humana requested files of up to 300 megabytes each; submit multiple records at once; and view requests completed or canceled and the names of uploaded files.
- Take advantage of the preauthorization automation feature available on Availity for immediate determinations for some types of services. After submitting a preauthorization request, you might receive the message that “clinical review is required,” along with a button taking you to a questionnaire. Answering a short list of questions may result in approval, or you can submit clinical information relevant to the questions asked.
Source: Humana’s Your Practice, June 2018
The Texas Medical Association’s payment specialists continuously review health care payment plans’ newsletters and updates for items important to Texas physicians. Texas Medicine Today periodically publishes key excerpts from those newsletters that you might have missed.
If you have questions about billing and coding or payer policies, contact the specialists at paymentadvocacy[at]texmed[dot]org for help, or call the TMA Knowledge Center at (800) 880-7955. TMA members can use the TMA Hassle Factor Log to help resolve insurance-related problems. Visit www.texmed.org/GetPaid for more resources and information.
Last Updated On
October 05, 2018
Originally Published On
July 05, 2018