For information on how to submit a preauthorization for frequently requested services/procedures for your patients with Humana follow the links below.
Tag: Humana
Health Plan Representatives Updated 8/4/2025
The Health Plan Representatives List has been updated. This is a good tool to print and have close by when you have an issue.
The biggest change for claims issues will be HealthSpring (HCSC) formerly Cigna MA. Here is how:
- Email ALL claims issues to [email protected]
2. HealthSpring has supplied the spreadsheet that MUST be used. A link is provided below, or you may call POET, we will be glad to email you an electronic copy.
Only the columns with Red Lettering, need to be filled out by the Physician’s office.
4. Always feel free to copy [email protected] if you would like POET to be in the loop.
5. If you have a time sensitive, special, or just an issue you would like to discuss with POET, please call (936) 637-7638.
Humana
TIPS, TRICKS AND HELPS
PREAUTHORIZATON LISTS (PAL):
Lists of services and medications effective July 1, 2025, that may required preauthorization for members with Medicaid, Medicare Advantage, and dual Medicare-Medicaid coverage are now available.
Easily determine if a prior authorization is required with Humana’s search tool. Search by Current Procedural Terminology (CPT®) codes, procedures or generic drug name(s). Remember to verify benefit coverage in Availity Essentials
Availity Essentials Introduces Check Claim Status Feature:
Availity has enhanced its Eligibility and Benefits (E/B) page by adding a Check Claim Status feature.
What you can expect:
- Improved efficiency and accuracy: The check Claim Status tool pre-populates your patient’s information, ensuring accuracy.
- Time savings: You can access claim status with one click- saving time and effort
https://provider.humana.com/
Humana’s Contract Numbers
Knowing the Medicare Advantage (MA) Contract number of the plans your office has opt’ed into can be a big help.
Some may say what is a MA contract number? Or you may have heard it called an H number.
The Centers for Medicare and Medicaid Services (CMS) is responsible for identifying each Medicare Advantage C plan with a unique contract number. This number is assigned to the insurance company during the approval process. For local managed care contracts, the number begins with an ‘H’ or a ‘9″.
Below are your H numbers for the Humana-POET contract.
The next time you are in doubt about a Humana Card, look for one of these numbers on the front of the card.
Humana Gold Plus H0028-041 (HMO)
HumanaChoice Giveback H5216-358 (PPO)
Humana USAA Honor Giveback H5216-348-000-2025 (PP0) This is the only Humana Military card under the POET Contract.
This isn’t the best example of a Humana card, but you can see the H number in the bottom right hand corner.
Do not be confused: Tricare for life is a 2ndary Plan and does not need a contract.
New! Search Tool Helps Streamline Prior Auths
Prior authorizations are often cited as one of the top burdens for healthcare professionals. To help streamline your workflow and save time, Humana has launched a new prior authorization search tool.
Now you can search by CPT® code, procedure or drug name to determine if authorization is required. You also can find guidance on how to submit medical and pharmacy authorizations.
Humana Physician News Q2 2024 Newsletter
NEW! 2024 preauthorization lists (PAL) and notification requirements Lists of services and medications, effective July 1, 2024, that may require preauthorization for patients with Medicare Advantage, Medicaid, dual Medicare-Medicaid and commercial coverage are now available.
NEW! 2024 provider manuals Humana Medicare and Medicaid provider manuals, effective March 15, 2024, are now available.*
Quality and Stars learning series Humana provides educational webinars each month, covering Quality and Stars-related topics for both learning purposes and continuing education credits.
Humana News
Humana Physician News Q1 2023
Just to mention a few topics:
- Financial Assistance for patients
- Real-time Benefit check
- Medication reconciliation for reduced hospital readmission
Humana Physician News
A Wealth of Information Just Waiting for You.
- Humana’s Neighborhood Centers offer patients one on one health education.
- Value-based care reduces acute care.
- Earn CME by attending the CMS Statin Webinar.
- Complete your annual 2022 Compliance Training.
- Many Resources and Support.
Humana Contract Amendment
Deadline for responding to the Humana Amendment has past.
Notice to participants in the POET Humana PPO contract: If you have not responded, this will default to acceptance.
If you have any question, please contact POET
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