MyHMHS for Providers Secure Services Portal
Humana Military’s secure services portal, “MyHMHS for Providers,” is designed to reduce the amount of time providers and their office staff members spend communicating with Humana Military via telephone or fax, which normally reduces the total time spent per transaction. These numerous online applications provide options designed to improve cash flow and increase office productivity.
Secure applications include:
- Claims status check
- Claims submission
- Consult reports (if applicable)
- Online referrals and authorizations (immediate confirmation may be available)
- Patient eligibility check
- Pharmacy data
- Diagnosis code lookup
- Transparency data
Additional applications include:
- Link to Fee Schedule
- Provider locator
- Schedule of upcoming provider seminars
A number of enhancements have been made to the “MyHMHS for Providers” portal to provide easier access to the information that impacts you and your practice. The following features have been either added or improved:
- Referrals and Authorizations
- National Provider Identifier (NPI) Registration and Maintenance
- Pharmacy Data Transaction Service
- Transparency
To access these features, which are described below in detail, registered providers can go to “ MyHMHS for Providers,” and log in using their user identification (ID) and password.
Referrals and Authorizations
The Referrals and Authorizations screens have been streamlined to make online referral and authorization requests simpler and more efficient. Submitting requests online saves time and allows you to receive immediate approvals.
The process for creating a referral or authorization request online includes the following five steps:
1. Enter Patient and Service Information
- Enter the sponsor’s Social Security number and the patient’s date of birth.
- Answer “Yes” or “No” to the question about other health insurance (OHI).
- Enter the date of service or allow the current date to default.
- Select “Evaluate Only” or “Evaluate and Treat.”
- Select the Category (type of specialty) and the specific Type of Service needed. (Example: Category = Cardiology; Type of Service = Cardiology Pediatric)
- Click “Continue.”
2. Select Procedures to Perform
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Identify procedure codes. Most types of service have procedures already identified; additional procedure codes may be added.
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Review any special messages about the procedures shown in red (Example: “No Referral Required” or “Non-covered Service” ).
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Click “Continue.”
3. Review Existing Authorizations (to prevent duplicates)
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Review existing authorizations for this type of service.
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Select whether you would like to update an existing referral or authorization, or whether you want to create a new one.
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Click “Continue.”
4. Select a Provider
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Accept the pre-selected provider.
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Select a provider from the list of alternatives.
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Search for a provider.
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Manually enter contact information for a provider.
5. Enter Clinical Data and Submit
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Update or confirm your contact information.
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Enter a diagnosis code and presenting symptoms or reason for the request.
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Enter up to five lines of pertinent clinical information that will be transmitted to the referred-to provider.
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Enter OHI information for the patient, if requested.
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Click “Submit.”
NPI Registration and Maintenance
The NPI Registration and Maintenance tool makes it easy to review and update NPIs with Humana Military. It allows authorized provider office personnel (administrators) to add and update NPIs for each category of providers: individual, active, in-network providers (Type I), and business organizations (Type II).
With the NPI Registration and Maintenance tool, you can:
- View a detailed list of provider names, specialties, and NPIs (if applied).
- Display the total number of providers with and without NPIs applied to their records.
- Enter NPIs for all providers and locations under a particular tax ID without having to log in again or use multiple usernames.
- Check the accuracy of the list of office locations that are in the Humana Military database.
- Flag office locations that are no longer active so that Humana Military can update its records accordingly.
Pharmacy Data Transaction Service
The Pharmacy Data Transaction Service (PDTS) feature allows you to review prescriptions filled for a beneficiary at MTF pharmacies, at TRICARE retail network pharmacies, and through the Mail Order Pharmacy. Providers with an approved referral or authorization from Humana Military may access this information. PDTS allows you to conduct a thorough, real-time online assessment that screens a patient’s complete prescription history before you write a new prescription.
Transparency
The “Transparency” page on the “MyHMHS for Providers” portal allows network providers to view information about administrative quality and practice affordability. Individual providers can access their measures and underlying data through the secure provider portal.
Humana Military’s transparency initiative is in support of Presidential Executive Order 13410, “Promoting Quality and Efficient Health Care in Federal Government Administered or Sponsored Health Care Programs.” The order calls for making relevant information available regarding health care quality and price in a readily usable manner. Humana Military’s approach reflects only positive information about providers. Each provider and office location is assigned zero, one, or two stars for each of two measurement categories: Administrative Quality and Practice Affordability.
Administrative Quality is based on two subsets:
These quality measures are aggregated to create a single score, or star rating. When there are no data available for a particular measure, the maximum score is assigned.
Practice Affordability is evaluated by comparing a provider’s average allowed charges for episodes of care to those of other providers in the same state. Charges for professional services surrounding specific events of care will be used to calculate each provider’s average. Variations in discounts and the intensity and volume of services rendered affect average allowed charges. Providers whose charges are significantly above the mean receive zero stars, those with charges below the mean are assigned two stars, and the remainder are assigned one star.
Humana Military plans to allow MTF providers to view star ratings of civilian network providers. This information is strictly for providers. There is currently no plan to share it with beneficiaries.
For more information on Humana Military’s transparency initiative, visit the “ MyHMHS for Providers” portal.
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