Humana Health Insurance Credentialing – Getting On the Panel

Let’s discuss the Humana Health Insurance Credentialing Process. 

Humana Inc is a health insurance company based in Kentucky, Louisiana. Over the years, it is responsible for amassing over 13 million Americans into its healthcare program. With revenue of $41.3 billion, Humana was ranked 56 on the Fortune 500 list.

Now, Humana credentials and re-credentials all licensed independent practitioners including physicians, facilities and non-physicians who fall within its scope and authority.

The following elements are crucial for a practitioner to be credentialed by Humana:
· Applying provider is in good standing with state and federal regulatory bodies.
· Applying Provider has been reviewed and approved by an accredited body.
· Every three years is still in good standing with state and federal regulatory bodies and is reviewed and approved by an accredited body.
· Liability insurance coverage is maintained.
· Copy of facilities State License.
· CLIA certificates are current.
· Completion of a signed and dated application.

As mentioned, Humana has at least 13 million Americans covered under its insurance program. Hence, it makes sense for providers to get in-network with humans to tap into what could potentially be a lucrative market. The process, however, is overwhelmingly tedious with too many moving parts. Thankfully, Denmaar’s team of experts will help assist you throughout the process.

The Process to Apply For Humana Health Insurance Credentialing

1. Pre Application

Before applying, Humana Health Insurance Credentialing requires practitioners to handover some necessary information to confirm that the applying practitioner is meeting basic guidelines of Insurance Credentialing with Humana. A Humana representative is assigned to the practitioner who informs whether the applying party meets all the mandatory guidelines or not.

2. Submit Your Application

Once the practitioner is deemed compliant of Humana’s Health Insurance Credentialing guidelines, they send an e-mail with an application packet containing all the information needed to get started.

If the application information already exists on the CAQH aka Council for Affordable Quality Healthcare exists on the CAQH or One Health-port website, then Humana will with the applying parties permission, proceed to access it electronically.

The Following application information is required from the applying party, depending on:
· Active and Unrestricted License in the State
· Drug Enforcement Agency Certificate (If Applicable)
· Good Standing With Medicare and Medicaid, Medicaid Number
· Humana participation in-hospital clinical privileges
· Board Certification Status
· Professional and Educational Training
· 5 Year of Work History
· Malpractice Claims History
· Adequate Malpractice Insurance
· Prior Sanctioning Activities

3. Follow Up

Once Humana receives the application packet, they will start the credentialing process. The entire process will take 45 to 60 days to complete.

During this time, the applying party will receive e-mails regarding:
· Confirmation of Application received
·  Request any missing documentation or application information. If any fundamental document or information is found to be absent during the process, Humana will send a notification, notifying about the closure of that particular application.
· Constant updates about the status of an application, including delays if any.

4. Humana Approval

If Humana approves a particular practitioner’s application, the practitioner becomes an in-network provider with Humana. Humana will update the provider information in their database within the next 10 business days.

Being a Humana in-network provider although tedious, is essential for providers to get clients who are covered under the Humana Insurance program. We at Denmaar, understand that medical practices would rather focus their energies on treating their patients rather than focus on the tedious task of credentialing. Hence, we offer a robust end to end credentialing solution that assists you throughout the process.