Humana - Service Fund offset/reimbursement related to Humana copay, coinsurance and deductible waiver

June 11, 2020

Dear physician and office administrator:

Effective May 1 through Dec. 31, 2020, Humana is waiving copays, coinsurance and deductibles for in-network primary care, behavioral health and telehealth visits. For Medicare Advantage value-based primary care physicians, Service Fund will offset non-capitated PCPs — and reimburse capitated PCPs — for members’ responsibility related to office and telehealth visits with their current PCP or within their PCP practice group. If all members on a PCP’s panel have no cost share, the PCP will see no adjustments.

Service Fund will begin processing in the July cap run (PE20200801). Processing will occur monthly with a two-month lag through the June 2021 cap run (PE20210601). This will include claims with dates of service from May 1 through Dec. 31, 2020, processed through the May 2021 cap run (PE20210401).

Adjustments will be reflected in the Balance Adjustments (REMAD635) data file, with adjustment reason code 952 — Credit for Waived Member Cost Share. Credit will be applied to the fund to which the claim is expensed. As a general rule, credit adjustments will be applied to the private fee-for-service (PFFS) and Medicare Part B (PRTB) funds, and payment adjustments to the primary care (PCRE) fund.