Claims

Claims

The mailing addresses for claims processing and correspondence are:
 

For Project HERO

Humana Veterans Claims
PO Box 7062
Camden, SC 29021
 
Humana Veterans Correspondence
PO Box 7063
Camden, SC 29021
 

For Project ARCH

Humana Veterans
PO Box 14320
Lexington, KY  40512-4320 or
 
You may also submit Project ARCH claim inquires to: HVHSClaims@humana.com
 
Clean claims will be processed and paid within 30 days. Payment for clean claims not processed within 30 days will include interest payments. A “clean claim” is defined as a claim that has no defect or impropriety (including any lack of any required substantiating documentation) or particular circumstance requiring special treatment that prevents timely payment from being made on that claim.
 
The telephone number for inquiries regarding claims is 1-866-458-6630. Humana Veterans will only accept claims filed on forms CMS 1500  or UB-04 .
  

Authorizations

The Humana Veterans' authorization management processes will efficiently meet VA requirements to arrange for timely, clinically-appropriate, high-quality care.
 
The Department of Veterans Affairs will be responsible for initiating authorizations for all non-emergency care referred to the Humana Veterans network. The authorizations for care will be service specific. As a Humana Veterans network provider, you are only authorized to perform the specific services listed on the authorization form. Services performed that have not been specifically authorized will not be paid. Authorization functions will be coordinated with the veteran and the network provider by the Humana Veterans Customer Care Representatives (CCR).
 
To ensure a smooth-running authorization process, the CCR:

• Helps veterans access care through the use of efficient appointment scheduling.
• Processes authorizations in accordance with proposed performance standards.
• Helps provider by coordinating veterans’ appointments.

Humana Veterans will ensure that timely appointments are scheduled, receipt of clinical data is monitored, and claims from network providers are appropriately adjudicated.
 
No Care Will Be Paid For That Has Not Been Authorized By The DVA And Humana Veterans.
 
For all inpatient, outpatient and individual health care services, the care must be authorized by DVA and Humana Veterans. All authorizations will come by way of a phone call and an authorization form .