Transition Period Billing for an Active Course of Treatment
Governs billing and claims processing 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 first 90 days of enrollment; applies to providers submitting claims to Humana MA products.
No material clinical or coverage changes in this revision.
Coverage Criteria for Transition-Period Services
Coverage criteria for transition-period services
Covered when ALL of the following are met:
ALL of the following
ONE of
- Service was furnished as part of an active course of treatment that began before the member's enrollment in the specific Humana MA plan
- Service was furnished during the enrollment's transition period (the first 90 days of that enrollment)
- Service was furnished to a member of a Humana Medicare Advantage plan (not a PFFS plan)
- Service is a basic Medicare benefit that, apart from this exception, may otherwise be subject to plan prior authorization requirements
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