Our Focus Remains on Your Success—Even When Claims Don’t Go as Planned

At Collective Revenue Management Solutions, our focus is — and always will be — on your success. Recently, many optometry practices have begun experiencing widespread denials from Humana Medicare Advantage plans. These denials often state that a modifier is needed to unbundle the exam from other services on the claim.

According to the American Optometric Association (AOA) this issue stems from a nationwide change in Humana’s claim processing system after implementing a new AI program. The AOA has confirmed that they are aware of the problem and working with Humana to identify a permanent fix.

While this process unfolds, our team isn’t waiting on the sidelines to get your claims paid.

Our Proactive Approach

At Collective Revenue, we believe your revenue cycle deserves constant attention — not delay. That’s why our billing specialists are actively monitoring and identifying these specific Humana Medicare Advantage denials within client accounts.

Rather than write these claims off or remove them from your reports, we are intentionally keeping the balances visible on your A/R. This ensures transparency while allowing us to track any future automatic reprocessing that Humana may perform once a fix is in place.

In the meantime, our team is submitting targeted appeals in an effort to overturn denials and secure payment sooner, instead of waiting for the AI correction process to resolve itself.

Our goal is simple: to minimize the impact on your cash flow and keep your claims moving forward.

What This Means for Your Practice

You may notice some open Humana Medicare Advantage claims aging in your A/R, even though appeals have been filed. Please know that this is intentional and strategic. By maintaining visibility on these claims, we can quickly reconcile any reprocessed payments once Humana issues a correction.

We will continue to update you as more information becomes available from the AOA and Humana. In the meantime, rest assured that our team is focused on finding solutions — not excuses.

Our Focus Is on Your Success

The optometric industry is evolving, and so is the billing landscape. As always, Collective Revenue remains committed to guiding your practice through every change with clarity, integrity, and proactive action.

Your focus is patient care.Our focus is your bottom line.