Topics
More on Claims Processing

Humana is expediting claims processing and prior authorization during COVID-19 pandemic

Prior authorization requirements have hindered freeing up hospital beds due to delays in getting inpatients to post-acute care.

Susan Morse, Managing Editor

Humana has announced it is implementing simplified and expedited claims processing to get reimbursement payments to providers as quickly as possible during the COVID-19 crisis.

In addition, the company is expanding its policy of suspending prior authorization and referral requirements, instead requesting notification within 24 hours of inpatient (acute and post-acute) and outpatient care. This is applicable for all providers regardless of network affiliation for patient care related to COVID-19 and for in-network providers for patient care not directly related to COVID-19. Exceptions include transplant and genetic procedures, as well as pharmacy coverage.

These policies are applicable for covered plan benefits under individual and group Humana Medicare Advantage, Medicaid, and commercial employer-sponsored plans.

HIMSS20 Digital

Learn on-demand, earn credit, find products and solutions. Get Started >>

WHY THIS MATTERS

Humana said it is taking these actions to help ease financial concerns and give administrative relief for the healthcare provider community facing unprecedented strain during the coronavirus pandemic.

Prior authorization requirements have hindered freeing up hospital beds due to delays in getting inpatients to post-acute care. Humana's new policy is designed to speed up that process.

THE LARGER TREND

The coronavirus has infected over 216,000 people in the United States and has killed over 5,000, according to Johns Hopkins.

However, these are the confirmed cases. Many people infected with a mild case of COVID-19 have not been able to get tested due to shortages.

Hospitals and physicians report shortages on tests, personal protection equipment, ventilators and staff, with those on the front lines working long hours and living away from home to prevent spreading the virus to their families.

ON THE RECORD

"Humana is committed to supporting clinicians by providing practical solutions to help alleviate administrative burden and boost system viability during these extraordinary times," said Dr. William Shrank, Humana's chief medical officer. "This initiative is of utmost importance to us in enabling health systems and the physician community to devote as much time and resources as possible to frontline patient care."

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com