What is Humana Veterans Healthcare Services (Humana Veterans)?
Humana Veterans was established in 2007 to focus on providing health care solutions to Veterans of the uniformed services.  Humana Veterans is a wholly owned subsidiary of Humana Military Healthcare Services, Inc. (Humana Military). Humana Veterans has developed a network of credentialed professional providers, ancillary providers and facilities within 23 states.  Humana Veterans administers health care services to our nations deserving Veterans when their needs can not be met within the walls of the Veterans Affairs Medical Center (VAMC).
 
What is Project HERO?
Project HERO is a demonstration project sponsored by the Department of Veterans Affairs (DVA). HERO stands for (Health Effectiveness through Resource Optimization). The intent of the demonstration project is to provide access to an expansive network of high quality, cost effective health services and health care providers when eligible Veterans can not receive specific care directly through the VAMC.
 
How does a Veteran get referred to Humana Veterans?
The Veterans primary care physician and the local VAMC will refer the Veteran to Humana Veterans in the event the Veteran requires services that can not be provided at the VAMC.  When the Veterans VAMC physician makes the decision to send an “authorization for care” for the Veteran to Humana Veterans, the local VAMC will “authorize” the Veterans care by way of a facsimile to Humana Veterans.  This process is known within the walls of the VAMC as “fee care/fee services”.
 
How will the appointment scheduling process with Humana Veterans work?
At Humana Veterans, our goal is to ensure continuity of care for the Veteran between the VAMC, VA physician and the Humana Veterans network provider. An Humana Veterans associate will contact the Veteran within 3 to 4 business days following the receipt of an authorization from the VAMC. The Humana Veterans associate will facilitate a three way phone call between the veteran, the Humana Veterans provider and Humana Veterans to schedule an appointment at a time that is convenient for the veteran. Humana Veterans also has the ability to schedule an appointment on behalf of the veteran, regardless of whether or not the veteran is on the telephone.  We will schedule the appointment directly with the Humana Veterans provider if after a number of attempts to contact the Veteran, we have been unsuccessful.  In this instance, Humana Veterans will schedule the appointment and follow up with a letter to the Veteran confirming the appointment time, date and advising the Veteran where to call if she/he needs to change the appointment. Humana Veterans will also provide a follow up call to the Veteran prior to her/his appointment with the Humana Veterans provider. If for any reason the veteran needs to cancel or change this appointment, he/she may contact an Humana Veterans associate at 1-866-458-6630.
 
Personal Service:
Humana Veterans treats all Veterans “authorized” to Humana Veterans for health care with personal appointment making service in assisting the Veteran through the authorization and appointment process.  Humana Veterans will ensure that timely appointments are made for Veterans and referral information is communicated directly to Humana Veterans providers. An efficient timely appointment making process and personal service provided to the Veteran will guarantee high-quality specialty care is received along with accurate and  efficient payment to providers.
 
What are the requirements for returning consult reports to the VA?
Humana Veterans network providers are required to forward a consult or discharge report to Humana Veterans within 25 days of the Veterans appointment. Please forward all reports to Humana Veterans at 1-866-836-4991. This is a secure fax line that meets all HIPAA compliance standards.

• Diagnostic data (radiology reports) must be signed electronically and returned to Humana Veterans within 48 hours
• Abnormal test results are requested immediately by Humana Veterans

Who should I call with claims questions?
You should call PGBA at 1-866-458-6630
Option #2 is for authorizations and appointments and;
Option #3 is for claims
 
You may also contact your local Network Service Representative (NSR) by calling, 1-866-458-6630.
 
Where do I file claims?
Claims can be forwarded to:
 
Humana Veterans Healthcare Services
PO Box 7062
Camden, SC 29021
 
How will I know if a veteran has been referred to me by Humana Veterans for care?
A Customer Service Representative from Humana Veterans will contact you via telephone, with or without the veteran on the line, to schedule an appointment.  After the appointment has been scheduled, you will receive a faxed notification that clearly delineates the services that you have been authorized to perform along with the Veteran name, appointment time and date.
 
If I am a Provider and I have a contract inquiry who should I contact?
Please contact your local Network Service Representative (NSR) by calling,
1-866-458-6630.