Humana speak
A category of membership based upon the member's assignment to a PCP
Attributed
Giving one’s time and services to benefit the community
Humana Volunteers Policy
PDF Designed to help physicians and healthcare providers identify additional actionable opportunities for improving clinical outcomes at the point of care
Member Summary PDF
Identifies submission gaps between the provider’s data and Humana’s data that may inhibit accurate member condition reporting and timely submissions to CMS
Provider reconciliation program (PRP)
Where you would locate the total number of members attributed to a provider group?
RPOR
Annual, proactive provider interactions with a patient in the patient's home
In Home Assessment IHWA
Humana provides associates with flexible time off from work that can be used for such needs as vacation, personal or family illness, doctor appointments, school, volunteerism and other activities of the associate's choice.
Paid Time Off (PTO) Policy —Traditional Benefit Program
in-workflow delivery of Clinical Inferences and Previously Accepted Conditions
Point of Care Alerts (MRA)
Designed to educate providers on the accurate and complete documentation and coding at the highest level of specificity to reflect a patient’s true health status at the time of care.
The CaDET program
Where you would find a collaborative platform that allows ease of access to information, resources and tools related to Stars.
Stars Legend
Products/services (etc. Medicare, Medicaid, Commercial)
Line of Business
This policy requires use of a single credit card, the Humana Corporate Credit Card, to pay for approved travel related expenses and approved non-travel related, small business purchases of up to $3,000 per transaction.
Credit Card Program Policy
data received in the existing Shadow File is returned combined with HEDIS supplemental data, making the process of sending data easier on providers
Combined File (MRA Shadow File)
Promotes early detection and ongoing assessment of chronic conditions for Humana’s members. The goal is to help ensure patients receive a complete and comprehensive annual assessment, as well as identifying potential gaps in care and recommended screenings
The PAF program
Where you would find a secure, multi-payer platform where healthcare providers and health plans collaborate by exchanging administrative and clinical information
Availity Portal
Payment methodology that CMS uses to facilitate the accuracy of payments to Medicare Advantage organizations using the HCC model
Medicare Risk Adjustment
This benefit for associates who need to care for a family member experiencing a serious health condition as defined by FMLA.
Caregiver Leave Policy
Encounter-based CCDA or PDF with all required fields to be used for MRA coding • On Demand: Humana requests records • Subscription: vendor sends records after encounter is complete
Medical Record Retrieval (MRA)
A standardized, 365-day snapshot of a patient’s medical history. Demographic and medical data for commercial and Medicare Advantage patients
Member summary with clinical inference (MSCI)
Where you would find the most up-to-date versions of approved external educational materials
HQRI Sharepoint
Describes providers that have a shared savings arrangement (Medical Home, Partial Downside or Global) with Humana
Value- Based
Associates may have access to confidential and proprietary information owned by or related to Humana. Associates are required to keep information confidential and not to disclose any such information.
Confidentiality Policy or HIPAA
Humana PAF to support EMR data element requirements
Provider Assessment Form (PAF) Template
List sent to providers contains potential, clinically-inferred conditions that are undocumented, potential chronic conditions, which Humana’s clinical algorithms have predicted a member may have, based on such data as doctor visits, prescriptions, durable medical equipment and laboratory results.
Clinical Inference Flat File
Where you would find with documents for all things associated with "connectivity"
EMR Connectivity Resources page