Humana (Commercial) - Quick Reference, What You Need to Know...
Search Options
-
No changes in search options or search criteria. Depending on the data
source being used,
this payer supports the following search options. In some cases, it may
be optional or required
to specify an Eligibility Coverage Type or a Relationship to Subscriber
when making an inquiry.
1. Member ID and Date of
Birth.
2. Medicare Number and Date of Birth.
3. Medicaid Number, Medicaid State, and Date of Birth.
- For
successful transaction processing, dependent data may be promoted to the
subscriber loop.
- In
some cases, the 3rd search option may also require the Patient’s City,
State, and Zip Code.
Dates
-
No changes in date rules. This payer
requires only the begin date for an inquiry.
-
This payer supports, up to two years in
the past and up to one year in the future.
-
No date spans are allowed. Previously,
future dates were not allowed.
-
Inquiry dates now reference a Plan Date -
291 (DTP01).
-
As before, the response specifies both
Eligibility Date – 307 and Service Date – 472 qualifiers.
(2100C/D Loop, DTP01)
Response Data
Benefits
The following information is based on a
generic “Health Benefit Plan Coverage - 30” inquiry.
Disclaimer
This document is not intended to identify every scenario that may be
presented in the payer response.
It should
also be noted, that the payer response may vary depending on the search
criteria used in the initial inquiry.
Some content
is no longer returned in the X12 5010 271 response. In a similar fashion,
some content has been
modified and
new response information may be returned. Information that appeared
consistent between the
4010 and 5010
responses was not presented in this document.