Humana Provider Payment Integrity Medical Records Management Policy

Healthcare providers who receive a medical record request from Humana may send medical records, itemized bills, invoices and other documentation via one of the following options:

    Upload requested documents  to Humana’s Medical Records Management (MRM) tool on Availity Essentials Portal, where all open medical record requests can be viewed. Uploading records online allows for faster adjudication of claims.            Log in to Availity Essentials at Availity.com. (If you are not registered, select “Register” and complete the registration process to obtain a user ID and password.)

        From the “Payer Spaces” menu, select “Humana.”

        From the “Applications” tab, select “Medical Records Management,” locate the record request, and upload the records. 

        Verify the requested medical record documentation has been received.

        For more information about working with Humana online, visit Humana.com/ProviderSelfService.



    Mail requested documents to:
    Humana Medical Records Management
    P.O. Box 14465
    Lexington, KY 40512-4465

    Fax requested records to 866-305-6655.

To ensure the medical records are indexed correctly, please attach the medical record request letter from Humana for each claim. 

If you have questions or need further assistance, please call at 800-438-7885 (TTY: 711). Representatives are available Monday through Friday, from 8 a.m. to 8 p.m., Eastern time. For address updates, be sure to tell us all locations associated with the healthcare provider for which address changes are needed.

Your cooperation is essential, and your prompt attention is appreciated. Without the requested records, your claim might be denied or adjusted. Please refer to the Humana Provider Payment Integrity Technical Denial Policy for details.

The Health Insurance Portability and Accountability Act (HIPAA) Security Rule requires providers to have a data backup plan, in addition to a disaster recovery plan to restore any loss of data. Humana expects providers to maintain compliance by ensuring adequate measures are taken to backup medical records and claims-related documents. Humana expects that all providers have cyber security insurance or other means of protection in the event of a data breach, hacking, or electronic disaster. Humana will not pay claims without supporting documentation if the provider claims that records no longer exist.

Humana does not prepay for medical record copies; reimbursement is made once record requests are fulfilled. Invoices for medical records copying fees should be routed through the MRM system for the fastest processing. You also have the option to mail or fax the requested documents using the information at the top of this page. Please include your HMRM Request ID on the invoice for fastest processing.

Reimbursement for copying fees will be made at the contracted rate. If there is no rate specified in the healthcare provider’s participation agreement or there is no contract, reimbursement will be made as follows:

    The Centers for Medicare & Medicaid Services’ (CMS) rate of 12 cents per page or up to $15 maximum per record, or

    In the case of commercial claims, the rate outlined in the state statute.

Humana will follow all applicable federal and state laws and regulations, Humana policies and procedures and any applicable contract language. When more than one state is impacted by a particular issue, to allow for consistency, Humana will follow the most stringent requirement(s). This standard is subject to change or termination by Humana at any time. Humana has full and final discretionary authority for its interpretation and application.

Denial for Lack of Medical Records Policy

Integridad de pagos y disputas​​

Integridad de pagos y disputas