You have the right to file a grievance or appeal with Humana Healthy Horizons® in Kentucky regarding a healthcare service, claim for reimbursement, provider payment or contractual issue. After receiving your grievance or appeal, we will review and respond with the results of our review or ask for additional information.
Grievances
We hope that you never have a grievance to report to us, but if you do, we want to hear about it and see how we can help.
A grievance is how a provider can notify us of dissatisfaction with anything other than an adverse benefit determination. For example, a provider can file a grievance because of processes/policies, claims processing (not an appeal), communications, fraud/waste/abuse or contracting/credentialing.
You must submit a grievance within 60 calendar days from Humana Healthy Horizons’ date of notice or action or date of original claim submission denial.
You can submit grievances by mail, phone or fax or via your secure Availity account.
Submit by mail:
Humana Healthy Horizons
Grievance and Appeal Department
P.O. Box 14546
Lexington, KY 40512-4546
Submit by phone:
800-444-9137
Submit by fax:
800-949-2961
Provider contracted rate disputes
A provider contracted rate dispute is considered a grievance. Use the provider Contracted Rate Dispute form, PDF to let us know of payment errors specifically related to the provider contract. All other issues must be submitted via the provider appeals process.
Please reference the Contracted Rate Dispute Process, PDF for details on how to submit.
You must submit a Contracted Rate Dispute form within 24 months of the processing date of the claim in question.
You can submit contracted rate disputes by mail, fax or via your secure Availity account.
Submit by mail:
Humana Healthy Horizons
Contracted Rate Disputes
P.O. Box 14546
Lexington, KY 40512-4546
Submit by fax:
800-949-2961
Appeals
An appeal is a request for review of an adverse benefit determination or payment denial decision by Humana related to covered services, services you provided or payment for a service. Providers have 60 calendar days from Humana Healthy Horizons’ date of notice or action or date of original claim submission denial.
You can submit appeals by mail, phone or fax or via your secure Availity account.
Submit by mail:
Humana Healthy Horizons
Grievance and Appeal Department
P.O. Box 14546
Lexington, KY 40512-4546
Submit by phone:
800-444-9137
Submit by fax:
800-949-2961
External independent review
If you are not happy with our resolution of your appeal, you can request review by an external independent third party. When you request this type of review, an independent third party outside of Humana’s internal appeal process will review your appeal and supporting documentation. Providers have 60 calendar days from receipt of appeal resolution to request review by the external independent third party. You must submit a request for an external independent review in writing via mail or fax.
Submit by mail:
Humana Healthy Horizons
Grievance and Appeal Department
P.O. Box 14546
Lexington, KY 40512-4546
Submit by fax:
502-508-1796
Submit by email:
GAMedicaidRightFax@humana.com
Dental and vision grievances and internal appeals
You can submit dental and vision grievances (including contracted rate disputes) and appeals to Avēsis by mail, email or via the Avēsis provider portal.
Submit by mail:
Avēsis Third-Party Administrators, Inc. LLC
Attn: Complaint Appeals and Grievances
P.O. Box 38300
Phoenix, AZ 85069-8300
Submit by email: ag@avesis.com
All external independent review requests must be submitted to Humana.
