Patient Administration

We realize that you perform administrative tasks in addition to tasks directly related to patient care.

To assist you with these tasks, we’ve consolidated the information below.

Member Billing

State and federal regulations prohibit providers from billing Humana – CareSource members for services provided to them. Humana – CareSource monitors this activity based on reports of billing from members.

Please note:  KYHealthNet is the resource to validate copay collection for Humana – CareSource members.

Covered Services

Regulations state that providers  must hold members harmless in the event that Humana – CareSource does not pay for a covered service performed by the provider unless Humana – CareSource denies prior authorization of the service and the provider notifies the member in writing that the member is financially responsible. This must be done prior to providing the service, and the member must sign and date the notification.

Missed Appointments

In compliance with federal and state requirements, Humana – CareSource members cannot be billed for missed appointments. Humana – CareSource encourages members to keep scheduled appointments and call to cancel, if needed.

Please call our Care Management department at 1-866-206-0272 if you are concerned about Humana – CareSource members who miss appointments.

Please call Provider Services for guidance before billing members for any services. You can reach Provider Services by calling 1-855-852-7005.

Member Rights & Responsibilities

As a Humana – CareSource provider, you are required to respect the rights of our members. Humana – CareSource members are informed of their rights and responsibilities via their Member Handbook. Please review our members’ rights and responsibilities and ensure your practice is in compliance.

Member Privacy

The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule requires health plans and covered health care practitioners to develop and distribute a notice that provides a clear, user-friendly explanation of individuals’ rights with respect to their personal health information, as well as the privacy practices of health insurance plans and health care practitioners. The Kentucky Department of Medicaid Services (KDMS) provides a privacy notice directly to Medicaid members. The notice informs members about how KDMS is legally required to protect the privacy of member data.

As a health care practitioner, please follow the HIPAA regulations and make only reasonable and appropriate uses and disclosures of protected health information for treatment, payment and health care operations.