Humana strives to offer our members high-quality healthcare at affordable rates. To achieve this goal, Humana provider payment integrity (PPI) reviews Humana’s claims payments for accuracy and requests refunds if claims are overpaid or paid in error.
Common reasons for overpayments include, but are not limited to:
If you wish to dispute an overpayment, please follow the appropriate process as outlined below:
These resources can help when you are interacting with PPI’s medical record review team.
Once a claim has been identified as overpaid, Humana may send a written notice of overpayment within the applicable time frames for each of Humana's products. Humana follows state regulations, provider contract requirements and CMS provisions when processing overpayments and recoupments.