Claim-Payment Inquiries

Please follow the process outlined below to make a claim-payment inquiry or submit an appeal or dispute:

Online

Appeals and disputes for finalized Humana Medicare, Medicaid or commercial claims can be submitted through Availity’s secure provider portal, Availity Essentials. To get started:

1. Sign in to Availity Essentials.
2. Use the Claim Status tool to locate the claim you want to appeal or dispute, and then select the Dispute Claim button on the claim details screen. This adds the claim to your Appeals worklist but does not submit it to Humana.
3. You can submit the appeal or dispute to Humana immediately or wait until later and submit it from your Appeals worklist.
4. To access your Appeals worklist at any time, go to “Claims & Payments,” then select “Appeals.”

Additional details can be found at Manage claim appeals and disputes online, PDF

• Availity Essentials resources:
  • For training, visit Humana.com/ProviderWebinars
  • Find helpful resources on how to use Availity tools and features by logging in to Availity Essentials and using the Help & Training menu located on the main navigation bar.
  • Find help with technical website issues by contacting Availity Client Services at 800 AVAILITY (282-4548), Monday – Friday, 8 a.m. – 8 p.m., Eastern time.

Mail

You can submit claim disputes via mail to:

Humana Correspondence
PO Box 14601
Lexington, KY 40512-4601

Please be sure to include:

1. The healthcare provider’s name and Tax Identification Number
2. The Humana-covered member’s Humana ID number and relationship to the patient
3. The date of service, claim number and name of the provider.
4. The charge amount, actual payment amount, expected payment amount and a description of the basis for the contestation.
5. Contact information for Humana’s response.

Phone claim-payment inquiry:

Call Humana’s provider call center at 800-448-6262. Our representatives are trained to answer many of your claim questions and can initiate contact with other Humana departments when further review or research is needed.

1. Note the reference number issued to you by the provider call center representative, as it may be needed in the future.
2. If your issue is still outstanding and has not been adequately addressed by the call center representative, you have the option to speak to a provider call center supervisor. Based on availability, you will be connected to a supervisor or a supervisor will contact you within 48 hours of your request.
3. In some situations, the call center representative will route your issue to an internal team at Humana. If this occurs, you will receive a letter or updated explanation of remittance from the Humana department that completes the additional review/research.

Participating providers – Escalation

Most inquiries receive a response in 30 to 45 days. Please allow us time to properly research and resolve your inquiry before contacting us again.

If you are a participating provider and disagree with our determination after we respond to your initial online, mail or phone submission, you can escalate your concern. Send a secure email to HumanaProviderServices@humana.com. Include the Claim Escalation Form , PDF with all necessary fields completed. List all reference number(s), interaction number(s) or invoice number(s) associated with previous attempt(s) to resolve the inquiry.

Look for an “Acknowledgment of Submission” email with a tracking number within 5 business days of your submission. You will receive a follow-up email every 14 days thereafter.

Nonparticipating providers

Nonparticipating providers can find details on how to appeal determinations on Medical Claim Payment Reconsiderations and Appeals.