Humana Medicare Advantage
We have begun to see Humana Medicare Advantage claims processing with payments issued toward the end of December. This is a positive development. We are continuing to actively monitor claims activity to ensure consistency and to identify any remaining issues. If you continue to experience denials or irregular processing, please report those instances so we can better assess the scope.
Anthem, Kentucky Employee Health Plan
We are seeing an increase in claims processing errors related to cost sharing under Anthem, specifically impacting the Kentucky Employee Health Plan.
Several claims are reflecting both a copay and deductible or coinsurance applied to the same visit. For chiropractic services, cost sharing should be structured as either a copay or deductible/coinsurance, not both.
We have been informed this is a system glitch on Anthem’s side. Anthem anticipates this issue will be corrected on or around February 1.
What to Do Now
- Continue submitting claims as usual.
- Review explanations of benefits carefully for improper cost sharing.
- Appeal Anthem claims when cost sharing is applied incorrectly. Appeals may be submitted directly through Availity. We recommend copying and pasting the patient’s specific plan benefit language into the appeal.
- Report ongoing or unresolved issues so we can continue to track and escalate as needed.
We will provide additional updates as more information becomes available.
