medical-records

Provider payment integrity policy for medical records management

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

  1. Mail the records to: Humana Medical Records Management, P.O. Box 14465, Lexington, KY 40512
  2. Fax the records to: 1-866-305-6655
  3. Upload the records to: Humana.com/providers (registration required)
    • In order to access the “MRM upload” application, users must be registered on Humana’s website. Those who haven’t registered should follow these instructions:
    1. On Humana.com/providers, select “Register.”
    2. Select “Provider” on the “Please tell us who you are” screen to start the provider registration process.
    3. Follow the instructions on each page to move through the application process.
    • After logging into Humana.com/providers, select the “Medical Records” tab in the upper-right corner of the page. Select “Open/Unfulfilled Requests” and choose the appropriate request.

To ensure the medical records are indexed correctly, please attach the original request letter from Humana.

If the address or health care provider name is incorrect on the medical record request, contact the Humana Provider Payment Integrity (PPI) Customer Service Department at 1-800-438-7885, 24 hours a day, seven days a week and provide the correct information. Specify if the address applies to any other location associated with the facility and/or the health care provider.

You can verify that records have been received by Humana by logging in to the secure provider portal at Humana.com/providers or by contacting PPI customer service.

Humana will send the original request and will then generate a new request every 30 days until the request has been fulfilled or a technical denial is issued for failure to respond to a request for medical records. If records have been sent, but requests continue to be received, please contact PPI customer service for assistance. Please refer to the PPI policy for technical denial.

Payment for copying fees shall be made at:

  1. The rate explicitly outlined in the health care provider’s contract, or
  2. The Centers for Medicare & Medicaid Services’ (CMS) rate of 12 cents per page or up to $25 maximum per record, or
  3. In the case of commercial claims, the rate outlined in the state statute.

All invoices should be routed through the MRM system. Humana does not prepay for records, and reimbursement is made once record requests are fulfilled.