[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-195197-105":53,"doc-detail-195197-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","provider-manual-delegated","Provider Manual - Delegated","","Provider communication guidance for delegated workflows with Humana, centered on Electronic Data Interchange (EDI) and supported healthcare transactions. Includes recommended EDI claim and eligibility/service inquiries and responses, plus fraud, waste, and abuse reporting contacts. Provides customer service pathways for benefits, claims, copayments, contracts, eligibility, grievances, and directory issues. Covers member eligibility inquiry methods via Availity Essentials, EDI transaction 270/271, and state-specific Medicaid and Medicare phone options, along with prior authorization review and referral submission and inquiry details.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":51,"@type":70,"position":76},"https://docshare.wps.com/template/general/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/provider-manual-delegated/195197/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/provider-manual-delegated/195197.png","ImageObject",442,249,{"name":88,"@type":89},"Eliana","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-29","2026-09-03",true,{"@type":98,"interactionType":99,"userInteractionCount":47},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"Which EDI transactions are recommended for exchanging healthcare information with Humana?","Question",{"text":108,"@type":109},"Providers are encouraged to use EDI transactions including the 837p Healthcare Claim, 270/271 for Healthcare Eligibility Benefit Inquiry and Response, and 278 for Healthcare Services Review and Response (and related inquiries/responses).","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"How can providers submit member eligibility inquiries to Humana?",{"text":113,"@type":109},"Providers can sign in to Availity Essentials, submit a B2B or batch Health Care Benefit Inquiry and Response (270/271) via EDI, or use the telephone numbers listed for Medicare Advantage and each state Medicaid program.",{"name":115,"@type":106,"acceptedAnswer":116},"What is the process for prior authorization, notification, and referral submissions and inquiries?",{"text":117,"@type":109},"Providers can sign in to Availity Essentials, submit Health Care Services Review and Response (278) via EDI, or call 800-523-0023 24/7. The Prior Authorization Search Tool is used to determine whether prior authorization is required by CPT codes, procedures, or generic drug names.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},195197,1788446162,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":50,"category_name":51,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":47,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":135,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":125,"read_time":20},4398048949847,"https://ap-avatar.wpscdn.com/avatar/400002536579ef2da7f?_k=1778318612642679267","| Electronic Data Interchange (EDI): To exchange information with Humana quickly and efficiently, providers are encouraged to use EDI transactions, such as the following:\u003Cbr>• Healthcare Claim: Professional (837p)\u003Cbr>• Healthcare Eligibility Benefit Inquiry and Response (270/271)\u003Cbr>• Healthcare Services Review and Response (278)\u003Cbr>• Healthcare Services Inquiry and Response (278)\u003Cbr>For additional transactions and detailed information, visit [Humana.com/EDI](Humana.com/EDI) |  |\n| --- | --- |\n| Fraud, Waste and Abuse: Humana Hotline: 800-614-4126 |  |\n| Humana Customer Service: Call 800-457-4708 or the number listed on the back of the patient’s Humana ID card, Monday – Friday, 8 a. m.– 8 p. m., Eastern time, for assistance with questions regarding: |  |\n| • Allowed amounts and fee schedules\u003Cbr>• Benefits\u003Cbr>• Claims\u003Cbr>• Copayments\u003Cbr>• Copy of contract and effective dates | • Eligibility\u003Cbr>• Grievances and/or appeals\u003Cbr>• Participating/non-participating inquiries\u003Cbr>• Provider directory concerns |\n| Member Eligibility Inquiries:\u003Cbr>• [Sign in to Availity Essentials at](Sign in to Availity Essentials at Availity.com)[ ](Sign in to Availity Essentials at Availity.com)[Availity.com](Sign in to Availity Essentials at Availity.com), or\u003Cbr>• Submit a B2B or batch Health Care Benefit Inquiry and Response transaction (270/271) via EDI, or\u003Cbr>• Telephone:\u003Cbr>- Medicare Advantage members call 800-457-4708, daily, 8 a. m.– 8 p. m., Eastern time\u003Cbr>- Florida Medicaid members call 800-477-6931, Monday – Friday, 8 a. m.– 8 p. m., Eastern time\u003Cbr>- Illinois Medicaid members call 800-787-3311, Monday – Friday, 8 a. m.– 8 p. m., Central time\u003Cbr>- Indiana Medicaid (Indiana PathWays for Aging) members call 866-274-5888, Monday – Friday, 8 a. m.– 8 p. m., Eastern time\u003Cbr>- Kentucky Medicaid members call 800-444-9137, Monday – Friday, 7 a. m.– 7 p. m., Eastern time\u003Cbr>- Louisiana Medicaid members call 800-448-3810, Monday – Friday, from 7 a. m.– 7 p. m.\u003Cbr>- Ohio Medicaid members call 877-856-5707, Monday – Friday, 7 a. m.– 8 p. m., Eastern time\u003Cbr>- Oklahoma Medicaid members call 855-223-9868\u003Cbr>- South Carolina Medicaid members call 866-432-0001\u003Cbr>Note: A copy of the Medicare enrollment form can serve as verification of eligibility for Medicare members who have not received their member ID card at the time of service. Members may not be denied covered, medically necessary medical services.\u003Cbr>Humana’s verification does not guarantee payment. If Humana subsequently learns that the member was ineligible on the date of verification, no payment will be made. Therefore, it is important that providers always ask a patient for his or her most recent insurance status. |  |\n| Prior authorization, Notification and Referral Submissions and Inquiries:\u003Cbr>• [Sign in to Availity Essentials at](Sign in to Availity Essentials at Availity.com)[ ](Sign in to Availity Essentials at Availity.com)[Availity.com](Sign in to Availity Essentials at Availity.com).\u003Cbr>• Submit a B2B or batch Health Care Services Review and Response transaction (278) via EDI, or\u003Cbr>• Telephone 800-523-0023, 24 hours a day, 7 days a week\u003Cbr>• Determine if a prior authorization is required with our Prior Authorization Search Tool. Search by CPT codes, procedures or generic drug name(s) . |  |","cbCaimFe79rZXDAC","https://ap.wps.com/l/cbCaimFe79rZXDAC","pdf",821496,41,"English","# Electronic Data Interchange (EDI)\n## Recommended EDI transactions\n# Fraud, Waste and Abuse\n## Humana Hotline\n# Customer Service Contacts\n## Assistance topics\n# Member Eligibility Inquiries\n## Availity Essentials and EDI 270/271\n## Telephone contacts by member type\n# Prior Authorization, Notification and Referral\n## Submission and inquiry channels","[{\"question\":\"Which EDI transactions are recommended for exchanging healthcare information with Humana?\",\"answer\":\"Providers are encouraged to use EDI transactions including the 837p Healthcare Claim, 270/271 for Healthcare Eligibility Benefit Inquiry and Response, and 278 for Healthcare Services Review and Response (and related inquiries/responses).\"},{\"question\":\"How can providers submit member eligibility inquiries to Humana?\",\"answer\":\"Providers can sign in to Availity Essentials, submit a B2B or batch Health Care Benefit Inquiry and Response (270/271) via EDI, or use the telephone numbers listed for Medicare Advantage and each state Medicaid program.\"},{\"question\":\"What is the process for prior authorization, notification, and referral submissions and inquiries?\",\"answer\":\"Providers can sign in to Availity Essentials, submit Health Care Services Review and Response (278) via EDI, or call 800-523-0023 24/7. The Prior Authorization Search Tool is used to determine whether prior authorization is required by CPT codes, procedures, or generic drug names.\"}]","Provider Manual - Delegated | PDF"]