Wednesday, September 27, 2017 Problems With Humana Claims? Let APTA Know Physical therapists (PTs) in several states are reporting claims difficulties with Humana's commercial and Medicare Advantage insurance plans, but more input from providers is needed. Recently, PTs from several states including Florida, Ohio, Kentucky, Louisiana, Virginia, and West Virginia have contacted APTA about Humana-related payment issues that include the retroactive application of the multiple procedure payment reduction (MPPR), further reductions to in-network providers' rates through the MPPR, confusion around Humana's approach to anatomical modifiers, and inconsistent application of the 59 modifier, with denials occurring even when the modifier was visible on the claim. In addition, the association has received reports of providers having difficulty accessing Humana personnel to discuss claims issues, and a lack of notification when policies and processes change. APTA staff have been in discussion with a representative from Humana to facilitate a resolution to the problems. As part of those efforts, APTA is urging members to contact the association by email at email@example.com, or by phone at 800/999-2782, extension 8511, to share any new or ongoing issues they've had with Humana. Need more information on retroactive claims denials and adjustments? Check out this APTA webpage. Also available: resources from Humana on postpayment recoupment, claims coding processing edits, and gaining a better understanding of other Humana processes.