Humana Removes Claim Edit; Physicians Asked to Re-submit Affected Claims

May 16, 2012

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On April 26, 2012 Humana implemented an edit enabling it to comply with the Centers for Medicare & Medicaid Services (CMS) requirement to change the format of reporting claim information to a fully compliant HIPAA 5010 837 file format for Medicare Risk Adjustment (MRA) purposes. Based on a recent CMS announcement that they would reevaluate their policy on the edit requirement, Humana is instructing its designated clearinghouse—Availity—to relax the edit until such time as CMS issues new guidance. 

Humana has taken immediate steps to remove this edit and is asking that providers resubmit affected claims as quickly as possible.

All regions/states are impacted. Specifically, any provider who directly submits through Humana’s designated clearinghouse, Availity, or submits through a clearinghouse that in turn submits through Availity would be impacted (between April 26th and May 10th).

Physicians who directly submit to Availity and have additional questions can call 1-800–AVAILITY (282–4548) or contact them online at http://www.availity.com/about-availity/contact-us/. Physicians who submit through another clearinghouse that ultimately submits through Availity should work directly with their clearinghouse.