Transition Period Billing for an Active Course of Treatment
Governs billing and claim submission guidance for services that are part of an active course of treatment that began before a member's enrollment in a Humana Medicare Advantage plan during the 90-day transition period; intended for providers treating Humana MA members.
No material clinical or coverage changes in this revision.
Transition Billing Coverage Criteria
Transition billing criteria
Humana will not require prior authorization for basic Medicare benefits during the first 90 days of a new member's enrollment for active courses of treatment that began prior to enrollment; payment may be reviewed against permissible coverage criteria.
ALL of the following
- Service was part of an active course of treatment that began before the member's enrollment
- Service was furnished during the member's 90-day transition period
AND provider appended transition identifiers OR supplied documentation
- Provider appended modifier TZ to professional or outpatient facility claims, or reported condition code 9T on inpatient facility claims (encouraged to facilitate processing)
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.