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2014 Humana

2014 Humana

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2014 Humana

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  1. 2014 Humana Maranda Merjudio Consultant, Network Relations- Michigan

  2. Why Register With Humana or Availity? • Secure website • Humana.com Provider Self-Service Center or Availity • Patient eligibility and benefits • Preauthorization requests • Referral authorizationand claims submissions • Referral authorization and claims status • Fee schedules • Membership roster • Code edits • 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

  3. 2014 Humana • 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. 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 Effective Jan. 1, 2014

  4. Radiology Preauthorization: HealthHelp • 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 • Call Humana Radiology Services at 1-866-825-1550 • 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 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 Insert form number via Header and Footer option or delete, if not needed