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Humana Dual Integrated (HMO D-SNP) in Michigan

Providers who care for Humana members in Michigan with integrated Medicare and Medicaid coverage can submit paper claims through the mail or electronic claims through their secure Availity Essentials account.

Paper claims should be mailed to:

Humana Claims 
P.O. Box 14359 
Lexington, KY 40512-4359

For electronic claims, sign in to your Availity Essentials account and select the Humana payer ID 61101 (fee-for-service claims/noncapitated) from the Payer drop-down menu before submitting.

Humana Dual Integrated HMO D-SNP ensures compliance target and turnaround times for electronic claims to be paid/denied comply within the following time frames:

Humana pays 95% of all clean claims submitted from providers within 30 calendar days of the date of receipt.

Humana pays 99% of all clean claims from providers within 90 calendar days of the date of receipt.

For all submitted claims, both paper and electronic, Humana issues payment within 30 calendar days of receipt of a clean claim, in which all requested documentation is provided, in the proper format, and does not contain any material defect, error or impropriety.

Working with Humana

Below we include information about electronic fund transfers, out-of-network claims, payment integrity, overpayments and disputes. If you have any questions, or need other information, contact Provider Services at 855-281-6070 (TTY: 711), Monday – Friday, 8 a.m. – 8 p.m., Eastern time.

Get paid faster

Get paid faster and reduce administrative paperwork via electronic funds transfer (EFT) and electronic remittance advice (ERA). Healthcare providers can use Humana’s ERA/EFT enrollment tool at Availity Essentials™ to enroll. To access this tool:

Sign in to Availity Essentials (registration required).

From the Payer Spaces menu, select Humana.

From the Applications tab, select the ERA/EFT Enrollment app. (If you don’t see the app, contact an Availity Essentials administrator to discuss your need for this tool.)

When you enroll in EFT, Humana claim payments are deposited directly in the bank account(s) of your choice.

Claim appeal process

If you disagree with the determination of a claim for a Medicare or Medicaid covered service, you have the right to file an appeal with Humana. 

An appeal is a dispute of a claim determination that a provider receives from Humana in which the enrollee is not at financial risk. Claim disputes include payment amount, payment denial or nonpayment of a claim.

Arbitration is a process that is initiated after the provider has exhausted its administrative appeals. If a participating or nonparticipating provider that has not signed a Hospital Access Agreement remains dissatisfied, the provider can submit a request for arbitration. Humana’s General Council will review all arbitration requests.

Rapid dispute is a process for nonparticipating hospitals that have signed a Hospital Access Agreement and disagree with Humana’s decision regarding payment resolution. The hospitals may submit a request to the Michigan Department of Health and Human Services for rapid dispute resolution.

Claim appeals must be received within 60 calendar days of the notice of Humana’s notice of claim outcome. It is Humana’s intent to resolve all claim and billing appeals as soon as possible but no later than 30 calendar days of receipt.

See Chapter 13: Provider Appeals of the provider manual for more information, which can be found on our documents and resources webpage. 

Appeals can be submitted via 1 of the following methods: 

Availity Essentials:

Navigate to Availity Essentials.

Select Claims & Payments.

Select Claim Status.

Enter the search criteria. 

Select the claim.

Select Dispute Claim.

Call center: Call 855-281-6070, and be sure to obtain the reference number for future use.

Mail: 
Humana Dual Integrated in Michigan
Attn: Provider Appeal
P.O. Box 14359
Lexington, KY 40512-4359

Managing overpayments online

If a provider identifies a claim that was overpaid, the overpayment should be reported and returned within 30 days of the payment identification. The overpayment application on the Availity Essentials portal can help you manage overpayments. You can: 

Manage overpayment documentation and maintain case histories electronically

Reduce overpayment resolution time by managing overpayment requests from multiple payers 

Request more information about or dispute an overpayment request 

Sign up for notifications when you have an overpayment 

View overpayment inventory in real time 

The overpayment application is in the Availity Essentials portal under the “claims and payments” section. If you do not see the application, ask your organization’s Availity Essentials administrator to grant you the “Claim Status” role. 

Humana provides written notice to the provider at least 30 calendar days before an adjustment for the overpayment is made. If a dispute is not received from the provider, adjustments to the overpayment are made on a subsequent reimbursement.

Refund checks for overpayments can be mailed to: 

Humana Dual Integrated in Michigan 
P.O. Box 931655 
Atlanta, GA 31193-1655 

Questions?

Call Provider Services at 855-281-6070 (TTY: 711), Monday – Friday, 8:00 a.m. – 8:00 p.m., Eastern time.

Visit Humana claims payment policies.



Presentación de reclamaciones

D-SNP en Michigan

Presentación de reclamaciones​​

D-SNP en Michigan​​

Presentación de reclamaciones

D-SNP en Michigan