Who they are
Plan types on the card
Humana Gold Plus (HMO), Humana Choice (PPO), and other Medicare Advantage products; dual eligible special needs plans; Medicaid in some states; and a smaller commercial book.Enrollment and credentialing
Start at provider.humana.com. Many transactions run through Availity. Credentialing generally pulls from CAQH.EDI, ERA, and EFT
Standard three-part enrollment.Appeals
Medicare Advantage appeals follow the federal MA appeals track, not a commercial process. The levels, deadlines, and independent review mechanisms differ from commercial appeals, and MA plans are not bound by Medicare fee-for-service’s 12-month timely filing limit. Their filing limits are contractual and frequently much shorter. See Medicare Advantage.Quirks worth knowing
- Prior authorization requirements are extensive on MA products: this is one of the more auth-heavy payers
- Risk adjustment and documentation matter more here than with most commercial payers, given the MA model
- CenterWell operates as a care delivery competitor in some markets