Health care providers will receive an initial findings letter detailing the overpayment amount.
Those wishing to dispute the findings must submit a formal, written Level One dispute letter along with all relevant documents within 60 calendar days from the date of the findings letter to avoid recoupment. Providers will also receive a final notice from Humana within 45 days of the date of the initial findings letter. Disputed claims will be reviewed by licensed personnel appropriate for the claim type (professional coder, physician, registered nurse, pharmacist, etc.). These personnel are different from the individual who made the initial overpayment determination. If recoupment has not been initiated, the overpayment is placed on hold so that monies are not recouped or offset from future payments until the dispute is resolved.
All Level One disputes should be sent to the Humana Clinical Audit Dispute Team:
Humana Provider Payment Integrity Clinical Audit Disputes
P.O. Box 14279
Lexington, KY 40512-4279
Level Two and Three disputes should be sent to the fax number/address above unless there is a specific address indicated in the previous dispute outcome letter.
To ensure proper routing and a thorough and timely review of your dispute, please include a copy of the dispute request form along with the original findings letter, previous dispute outcome letters and any other documentation that supports your dispute.