2014 Humana

Maranda MerjudioConsultant, Network Relations- Michigan

• Secure website

• Humana.com Provider Self-Service Center or Availity– Patient eligibility and benefits– Preauthorization requests– Referral authorization and claims

submissions– Referral authorization and claims

status– Fee schedules– Membership roster– Code edits

Why Register With Humana or Availity?

• Training and Help– Humana email: deployment@humana.com– Web-based training schedule:

https://www.humana.com/provider/medical-providers/education/provider-self-service/interactive

– What’s New: https://www.humana.com/provider/medical-providers/education/whats-new/

• Connectivity or Password Reset – 1-877-845-3480

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Primary care physicians initiate request for authorization or referral by submitting requests to Humana using any one of the following processes: • Humana.com (registration required)• Availity.com (registration required)• Phone: 1-800-523-0023

Primary care physicians receive a referral number from Humana if the request meets the following criteria:

• Complete request• Service is covered• Referred provider is an in-network provider • Medically necessary

Referral status can be verified by accessing Humana.com, Availity.com or by calling 1-800-523-0023.

Effective Jan. 1, 2014

2014 Humana

For the most up-to-date list of in-network health care providers, please visit Humana.com and look for the “Find a healthcare provider” tab

View the full Preauthorization and Notification List by product type at:www.Humana.com >Providers > Medical Providers > Education > Claims > Pre Authorization

• Preauthorization requirements apply to CT scans, MRAs, MRIs, nuclear stress tests, PET and SPECT scans, radiation therapy and cardiac catherization 1

• For additional information about radiology, please visit https://www.humana.com/provider/support/on-demand/ and choose “RadConsult Online”

• Preauthorization may be requested online or by phone– Online, visit portal.healthhelp.com/humana – By phone

o Call Humana Radiology Services at 1-866-825-1550o Representatives are available from 8 a.m. to 8 p.m. Eastern time, Monday

through Friday, and from 10 a.m. to 5 p.m. Eastern time, on Saturday

Radiology Preauthorization: HealthHelp

4(1) Radiology services which require preauthorization may be subject to change; refer to https://www.humana.com/provider/medical-providers/education/claims/pre-authorization to verify that the service requires a preauthorization

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