Paper Claim Administrative Fee
This policy governs Humana's administrative fee assessed for paper claims submitted on CMS-1500 or UB-04 forms for Medicare Advantage products; it affects providers submitting claims to Humana Medicare Advantage plans.
No material clinical or coverage changes in this revision.
When the Paper Claim Fee Applies
Paper claim fee criteria
Covered when ALL of the following are met:
ALL of the following
- Claim submitted on a CMS-1500 or UB-04 paper claim form
Physical paper form submission (not electronic).
- The reimbursement amount for the claim is equal to or greater than $10.00>= $10.00
- Assess $5.00 administrative fee for each qualifying paper claim
Fee applied per claim when the above conditions are satisfied.
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