At Humana, we are at the forefront of billing practices. We have procedures in place, such as electronic billing, to expedite the payment of your claims. If you rather file your claim on paper, you are welcome to do so, keeping in mind the following:
You may send your claims to the following addresses:
You can also file your claim through the clearinghouse of your choice. When sending your claim, use one of the following Humana identifiers:
Medicare Advantage: claims must be sent within one calendar year from the date the service was rendered.
Commercial Plans: claims must be sent within the time limit stipulated in the provider’s contract or as stipulated under applicable state law. Generally, these claims must be filed within a time period of:
You can verify the status of your claims using our online tools.
Press here to register or to access your account.
You can file your electronic referrals using our online tools. Press Sign in or Register to access your account. You can also file your referrals through:
We have redesigned our Conexión Humana Interactive Voice Response System, and optimized our technological tools in order to expedite procedures and deliver the best possible service.
You can use our system to verify eligibility, co-payments for services offered by our providers, request ID Card duplicates, certifications, referrals, authorizations of coverage, notices of admission, and ancillary or out-patient services, among others.
You can access the system by calling 1-800-611-1474 and following the provider’s menu options.
Press here to get instructions on how to request services through Humana.
Press here to get a list of providers with their Network Provider Identification (NPI).
The Centers for Medicare & Medicaid Services (CMS) ordered the replacement of the entire set of diagnosis and procedure codes of the International Classification of Diseases 9th Edition/Revision (ICD-9 in English, CIE-9 in Spanish) with those of the International Classification of Diseases 10th Edition/Revision (ICD-10, CIE-10) Clinical Modification (CM).
The Health Insurance Portability and Accountability Act (HIPAA) requires a specific typification of transactions for claims sent electronically. These standards are used to help improve the quality of service to patients, and the processing of claims and data reports.
Humana has received the Phase II Certification from the Committee on Operating Rules for Information Exchange (CORE). The CORE certification was awarded after completing all procedures for the Phase I and Phase II certifications. Obtaining the CORE Phase II Certification shows Humana’s commitment to its health services providers regarding improved access to patient information about benefits or insurance eligibility, before or at the time services are rendered to patients. Additionally, all CORE operation norms support crucial security and privacy practices.
Press this link to get more details about the Health Reform.
Humana complies with all federal and state laws. To get information about your rights under the Health Insurance Code and the Prompt Payment Law, visit the Office of the Commissioner of Insurance of Puerto Rico webpage using the following link:
http://ocs.gobierno.pr/ocspr/index.php/asuntos-legales/codigos-de-seguro
The contract with the Puerto Rico Health Insurance Insurance Administration (ASES) for the 2017 Platinum Medicare Program and applicable Federal regulations (42 CFR part 50, subpart B) requires urologists and obstetricians to complete the form Of Consent for Sterilisation to all beneficiaries who are going to perform the sterilisation procedure.
Press here To obtain the circular letter and documents for Consent of Sterilisation.