Provider Payment Integrity Policies

Provider Payment Integrity Post-Pay Clinical Audit Appeal Process
Find out more about the provider payment integrity clinical audit appeal process for health care providers. If a health care provider disagrees with Humana's findings, the provider has the right to appeal the results of an audit performed by Humana or Humana's third-party vendors.

Provider Payment Integrity Policy for Post-Payment Audits
Find out more about the provider payment integrity audit processes for providers.

Provider Payment Integrity Policy for After Discharge
Find out more about the provider payment integrity policy for rebilling Humana following a finding that the inpatient setting was not the most appropriate level of care.

Provider Payment Integrity Policy for Technical Denial
Find out more about the provider payment integrity policy for technical denials. A technical denial occurs when a health care provider does not respond to a request for medical records from Humana.

Provider Payment Integrity Policy for Medical Records Management
Find out more about submitting medical records to Humana's provider payment integrity department.

Provider Payment Integrity Policy for Prepayment Itemized Bill and Medical Record Review
Find out more about the medical record review process prior to payment.