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:

Sign in to Availity Essentials. 

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.

You can submit the appeal or dispute to Humana immediately or wait until later and submit it from your Appeals worklist.

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.

Availity Essentials resources:

For training, visit Humana.com/ProviderWebinars

Find helpful resources on how to use Availity tools and features by signing in to Availity Essentials and using the Help & Training menu located on the main navigation bar.

Find help with technical website issues by calling 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
P.O. Box 14601
Lexington, KY 40512-4601

Please be sure to include:

The healthcare provider’s name and Tax Identification Number

The Humana-covered member’s Humana ID number and relationship to the patient

The date of service, claim number and name of the provider.

The charge amount, actual payment amount, expected payment amount and a description of the basis for the contestation

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. 

Note the reference number issued to you by the provider call center representative, as it may be needed in the future.

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.

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.

Coding denial escalations and inquiries

Escalations around Code Editing disputes and denials should be submitted through Availity’s secure provider portal, Availity Essentials.

Sign in to Availity Essentials.

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.

You can submit the appeal or dispute to Humana immediately or wait until later and submit it from your Appeals worklist.

To access your Appeals worklist at any time, go to “Claims & Payments,” then select “Appeals.”

All other escalations

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 with all necessary fields completed. List all reference numbers, interaction numbers or invoice numbers associated with previous attempts 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 21 days thereafter.

Nonparticipating providers

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

Cómo realizar una consulta sobre el pago de reclamaciones o presentar una apelación o disputa

Facturación y pagos

Formulario de escalamiento de reclamaciones

Guía de consultas sobre reclamaciones de pago

Escalamiento al equipo de resolución de asuntos de PPI

Recursos para la consulta sobre el pago de reclamaciones de Humana Healthy Horizons® en Indiana

Recursos adicionales

Revisiones de procesos de reclamaciones

Integridad de pago y disputas

Reconsideraciones y apelaciones

Cómo realizar una consulta sobre el pago de reclamaciones o presentar una apelación o disputa​​

Facturación y pagos​​

Formulario de escalamiento de reclamaciones​​

Guía de consultas sobre reclamaciones de pago​​

Escalamiento al equipo de resolución de asuntos de PPI​​

Recursos para la consulta sobre el pago de reclamaciones de Humana Healthy Horizons® en Indiana​​

Recursos adicionales​​

Revisiones de procesos de reclamaciones​​

Integridad de pago y disputas​​

Reconsideraciones y apelaciones​​