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NETWORK ALERT

Humana wheelchair / scooter claims

WORK WITH HOMELINK ON ELIGIBLE WHEELCHAIRS/SCOOTERS

Last year’s changes to Humana’s durable medical equipment (DME) network significantly impacted many providers.
But you don’t need to turn away all Humana claims. HOMELINK is contracted nationwide with Humana for specified wheelchairs and scooters, including repairs.

We’ll help you recover claims that would otherwise be lost. Simply get in touch with us and we’ll handle the rest. We’ll submit the authorization on your behalf, handle all coordination, and ensure it gets submitted to Humana on time. We have years of experience in getting claims paid with Humana.

Here's what to do:

Identify and flag all Humana claims before turning them away

Cross-reference them with eligible wheelchairs and scooters (below)

Capture the business by
calling HOMELINK

Eligible Wheelchairs/Scooters, Nationwide

Download PDF

	NEW CHAIRS	REPAIRS
Group 1: K0800 - KO816, E1230, K0899
Group 2: K0820 - KO843
Group 3: K0848 - KO864
Group 4: K0001 - K0004, K0006 - K0007
Complex Manual: K0005, E1161

Here's where to start and what to expect.

So, you've received a new referral with a prescription for a wheelchair or scooter and completed an initial consultation with the patient. After reviewing their insurance information, you realize they have coverage through Humana. Now what?

FIRST, check the plan type: HOMELINK works with all kinds of different plans. As long as it is a non-Medicaid Humana plan, we've got you covered.
NEXT, verify the wheelchair or scooter. If it's one of the specified wheelchairs or scooters in the chart above, you can work directly with HOMELINK.
FINALLY, contact HOMELINK. We'll start the intake process, validate coverage, and make sure you're set up for success. Learn More

Here's what to expect: When you submit a referral with HOMELINK, we work side-by-side with you to make sure it's a seamless, efficient experience. We handle all coordination, including verifying plan coverage, confirming that it's medically necessary, gaining authorization, and obtaining any missing clinical documentation.

We're well versed in all kinds of unique situations, including many independent physician associations. Contact us for guidance.

We handle all the coordination

When you submit a referral with HOMELINK, we're with you every step of the way. You don't need to spend hours coordinating documentation, evaluation, and authorization - we handle all the legwork. We have a team of experienced patient care coordinators dedicated to keeping your claims moving.

Eligibility

Confirm patient eligibility and network status

Documentation/Evaluation

Capture prescription, medical necessity, history, and physical, in-home evaluation scheduling & support

Authorization

Code/modifier accuracy, coverage verification, appeals, provider & patient communication

Patient follow-up

Delivery confirmation, patient satisfaction, returns

You don't have to organize it all. We'll follow up every 48-72 hours to confirm authorization.

We make sure you get paid

We know billing can be complicated. So, we work with you to make sure the claim submitted to Humana is clean and ready to be processed. Once the claim is submitted to us, our system automatically checks for inaccuracies, errors, and omissions. Anything flagged is manually evaluated to make sure payment is quick and easy for you.

Member-specific information: validated patient information and member ID
Ordering doctor information: doctor name, national practitioner identifier (NPI), diagnosis
Service details: HCPCS billing codes, modifiers, quantities, descriptions, date of service, proof of delivery

Claim review and communication in 14 days or less. That’s our commitment to you.

We take care of all repairs, too - even if you got the chair somewhere else

We know wheelchairs break and that gaining authorization for repair can be a hassle. HOMELINK handles all the coordination for repairs, even if we didn’t help with the initial wheelchair. Once you’ve evaluated the repair needs, just submit the referral to HOMELINK, and we’ll handle the rest.

HOMELINK coordination:

Validate the warranty and check to see if authorization is required
Obtain all documentation for authorization when needed, and submit to Humana
Handle all communication with Humana and provider, including repair approval

We'll work with you on IPAs

At HOMELINK, we understand the complexities of working with independent physician associations (IPAs). For IPAs, the risk model plays a significant role in how the claim is paid out. We work closely with you to understand this in depth and ensure you feel comfortable moving forward.

Member benefit evaluation
Coverage confirmation with Humana
Provider communications on how to move forward

READY TO GET STARTED?

Coordinate My Claim (800) 482-1993

Frequently Asked Questions

Does Humana follow Medicare guidelines?

Yes. Humana follows LCD-NCD Medicare guidelines, including diagnosis-driven requirements. Please bill with the qualifying diagnosis when applicable, otherwise the claim could result in denial.

How do I bill for an anatomical modifier?

When bilateral accessories (2 units) of the same code are billed with the same DOS on the same claim they must be on separate claim lines.

Bilateral items not billed on separate claim lines will be returned as unable to be processed.
Claims returned as unable to be processed must be resubmitted with a corrected claim
Claims unable to be processed do not have appeal rights and cannot be reopened or submitted for adjustment.

Wheelchair Options/Accessories Affected: E0951, E0952, E0954, E0961, E0967, E0971, E0973, E0974, E0990, E0995, E1009, E1015, E1016, E1017, E1018, E1020, E2205, E2206, E2209, E2211, E2212, E2213, E2216, E2218, E2220, E2224, E2227, E2381, E2382, E2383, E2386, E2388, E2390, E2394, K0015, K0017, K0018, K0019, K0037, K0040, K0041, K0042, K0043, K0044, K0045, K0046, K0047, K0050, K0051, K0052, K0053, K0065, K0069, K0070, K0071, K0072, and K0077
Wheelchair Seating Affected: E0953, E0956, E1028 (RT/LT modifiers depending on the situation) and K0108 (RT/LT modifiers depending on the situation or item provided).

How do I bill for capped rental items that have an option to purchase?

Capped rental items with an option to purchase for the first month require a BP modifier.

How do I bill for capped rentals?

All capped rentals billed as rentals will require the corresponding capped rental modifier KH, KI, or KJ.

How do I bill for repair?

To bill for a repair, HCPCS K0739 is considered a covered labor code. No KX modifier is required.

When can I appeal or submit a corrected claim?

If a claim does not meet qualifications, providers must submit a corrected claim. These claims cannot be appealed, reopened, or submitted for adjustment without correcting the claim. These can be submitted electronically to HOMELINK using bill frequency 07.

What other coding requirements are there?

Effective 4/1/2024 HCPCS E2300 was made inactive. HCPCS E2998 is a replacement code and considered covered based on criteria and member coverage.

How do I submit a claim?

We suggest submitting your claims to HOMELINK via a clearinghouse whenever possible for quicker claims and payment processing.

Clearinghouse Claim Submission Options
- Smart Data Solutions: HOMELINK Payer ID 30750
- WCEDI/Data Dimensions: HOMELINK Payer ID LU536
- Availity: HOMELINK Payer ID 50701
Non-Clearinghouse Claim Submission Options
- Email: GetYourBillToUs@vgm.com
- Fax: 877-786-6579
- HOMELINK Portal: vgmhomelink.com/member/login
- Mail: HOMELINK, PO Box 211490, Eagan, MN 55121

MAKE A REFERRAL

for patient-centric, local care.

Phone: 800-482-1993 | Fax: 866-271-1814

Email: HOMELINKreferrals@vgm.com

Call (800) 482-1993