Humana Slamming Pharmacies for Invalid Faxed and Oral Prescriptions

Humana is going after pharmacies every way they can these days. Many states have specific elements that need to be present in the fax header of a faxed prescription. PAAS has seen numerous audits where the Humana auditor is marking a fax as an invalid hard copy if it is missing these required fax header elements.

Some examples are:

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  • Washington state: Faxes must contain date, time, and telephone number and location of the transmitting device (WAC 246-870-050)
  • Illinois: Fax header requirements include: prescriber fax number, time/date of transmission (IL 1330.760(c))
  • New Jersey: Faxes must contain header by LAW (see 13:39-7.10(e)) – including: identification # of sending fax machine, date/time of Rx transmission, name, address, phone and fax # of pharmacy, full name/title of authorized agent transmitting

Please be aware of your state requirements for faxed prescriptions. Contact your board of pharmacy for more information.

Humana is also going after pharmacies for invalid oral prescriptions. Some state laws require an oral order be promptly reduced to writing. PAAS sees some pharmacies use a fill sticker as a hard copy. Other pharmacies will reduce an oral order to type-writing. PAAS thinks that these procedures are fine, however, Humana has interpreted reduced to writing to mean hand-writing and has found a new way to line their pockets.

While these discrepancies are appealable, they are a hassle as you must obtain a physician statement on clinic letterhead to get paid for that prescription. Avoid chargebacks from Humana for oral orders by hand writing them if your state requires you to reduce an oral order to writing.