Are You Having Issues With Humana

October 9, 2017
 / 
Rick Gawenda
 / 

Private practices and facilities (skilled nursing facilities, rehab agencies and hospitals) are reporting difficulty getting paid for outpatient therapy claims with Humana’s commercial and Medicare Advantage insurance plans. The American Physical Therapy Association (APTA) has received many complaints from their members regarding the retroactive application of the multiple procedure payment reduction (MPPR), further reductions to in-network providers’ rates through the MPPR, confusion around Humana’s approach to anatomical modifiers, and inconsistent application of the 59 modifier, with denials occurring even when the modifier was visible on the claim.

APTA staff have been in discussion with a representative from Humana to facilitate a resolution to the problems. As part of those efforts, APTA is urging members to contact the association by email at advocacy@apta.org, or by phone at 800/999-2782, extension 8511, to share any new or ongoing issues they’ve had with Humana.


All material posted on our website is the intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without the prior written approval of Gawenda Seminars & Consulting, Inc.

This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

There are currently no comments.