Medical Resources
Medical Resources
Working in Availity
Availity is the preferred partner of Author by Humana for all electronic transactions. The Quick Start Guide linked below includes step-by-step walkthroughs for common transactions in Availity.
Availity Quick Start Guide, pdf opens new tab
Author by Humana ID Card Sample & Plan Information, pdf opens new tab
Please Note: Author by Humana uses a different Payer ID than Humana. If your practice is using a Clearinghouse or EHR/EMR to electronically submit eligibility verifications, authorizations, or claims through Availity, please confirm plans with service from Author by Humana have been configured with Author Payer ID: 61108.
Medical Prior Authorizations
The Author by Humana Right Care (Utilization Management) Team will intake all requests for medical prior authorization except those from orthopedists, oncologists, and radiation oncologists.
Author by Humana Prior Authorization List (PAL), pdf opens new tab
Authorization Request Form, pdf opens new tab
Electronic Submission Options:
Availity
Electronic Data Interchange
Payer ID: 61108
Cohere Health for Orthopedists
Cohere Quick Start Guide, pdf opens new tab
New Century Health for Oncologists & Radiation Oncologists
New Century Health Quick Start Guide, pdf opens new tab
Other Options:
Fax:
1-833-301-1006
Mail:
Author Right Care
PO Box 254
Sidney, NE 69162
Claims Submission & Payment
If you receive electronic payments from Humana, those preferences will carry over to your payments from Author by Humana. Otherwise, you may receive a separate paper check and remittance advice from Author by Humana in addition to your typical Humana documents. To avoid receiving these important documents separately, you can enroll in Electronic Funds Transfer (EFT).
Disputes Quick Start Guide, pdf opens new tab
How to Enroll in EFT, pdf opens new tab
Electronic Submission Options:
Availity
Electronic Data Interchange
Payer ID: 61108
Other Options:
Fax:
1-949-579-2964
Mail:
Author Claims
PO Box 253
Sidney, NE 69162
Please Note: If a claim is identified as overpaid, Author by Humana may send a written notice of overpayment within the applicable timeframe. Author by Humana follows state regulations, provider contract requirements, and CMS provisions when processing overpayments and recoupments. For more information, contact our Provider Navigators.
For Prescribers
Apart from those for oncology and radiation oncology, Prior Authorizations for Part B & Part D Medications are managed by Humana's Medication Intake Team (MIT). A request must be submitted and approved in advance for medications requiring a prior authorization. The Prescriber Quick Reference Guide linked below includes Electronic & Other Submission Options.
All Grievances & Medical Appeals
Participating providers may appeal on the patient’s behalf using the Medical Appeal Form linked below. Non-participating providers may appeal on behalf of themselves or on behalf of the patient, accompanied by a Waiver of Liability Form or Appointment of Representative Form.
Medical Appeal Form, pdf opens new tab
Waiver of Liability Form, pdf opens new tab
Appointment of Representative Form, pdf opens new tab
Grievance & Appeal Quick Start Guide, pdf opens new tab
Submission options:
Standard Fax:
1-833-301-1004
Expedited Fax:
1-833-301-1005
Mail:
Author Grievances & Appeals
PO Box 273
Sidney, NE 69162
Please Note: A request for an expedited appeal can be submitted if waiting for a standard response time frame could seriously jeopardize the member's life, health, or ability to regain maximum function. Expedited appeals are not used for claims that have already been paid or denied.