This webpage contains information for Humana participating and nonparticipating physicians, hospitals and other healthcare providers about medical claim payment reconsiderations and member appeals.

Submit appeals and disputes online

Appeals and disputes for finalized Humana Medicare, Medicaid or commercial claims can be submitted through Availity’s secure provider portal, Availity Essentials. Healthcare providers can:

  • Upload needed documentation with online submissions
  • Receive confirmation that submissions were received
  • Check the status of appeals and disputes submitted on Availity Essentials
  • View high-level determinations for completed online requests

To get started:

  1. Sign in to Availity Essentials (registration required, PDF)
  2. Use the Claim Status tool to locate the claim you want to appeal or dispute, then select the “Dispute Claim” button on the claim details screen. This adds the claim to your appeals worklist but does not submit it to Humana.
  3. You can submit the appeal or dispute to Humana immediately or wait until later and submit it from your appeals worklist.
  4. To access your appeals worklist at any time, go to “Claims & Payments,” then select “Appeals.”

Please note: This function is for appealing or disputing finalized claims only. It cannot be used for preauthorization-related appeals that do not involve a submitted claim or for disputes related to overpayments and Provider Payment Integrity (PPI). Please do not resubmit claim appeals and disputes previously sent by mail; duplicate submissions may delay processing.

For more information:
Download a flyer, PDF about online appeals.
Visit our provider webinars page to register for a Humana-led webinar on online appeals or other topics.

Information for participating providers

Participating providers may find the reconsideration processes in the provider manuals for physicians, hospitals and healthcare providers.

Information for nonparticipating providers

Medicare Advantage plans Commercial plans Medicaid plans

Medicare Advantage plans: appeals for nonparticipating providers

To request an appeal of a denied claim, you need to submit your request in writing, via Availity Essentials or mail, within 60 calendar days from the date of the denial. This request should include:

  • A copy of the original claim
  • The remittance notification showing the denial
  • Any clinical records and other documentation that support your case for reimbursement

You need to include a signed Waiver of Liability form, PDF holding the enrollee harmless, regardless of the outcome of the appeal. You can submit the request online via Availity Essentials or mail it to:

Humana Inc.
P.O. Box 14165
Lexington, KY 40512-4165

In Puerto Rico, please use this address:

Humana Inc.
Unidad de Querellas y Apelaciones
P.O. Box 195560
San Juan, PR 00919-5560

Commercial plans: appeals for all healthcare providers

If you believe the determination of a claim is incorrect, you may file an appeal on behalf of the covered person with authorization from the covered person. Some states may allow providers to file on their own behalf in certain circumstances. Please review the applicable state law for appeal rights.

The appeal will be reviewed by parties not involved in the initial determination. To request an appeal, you need to submit your request in writing within the time limits set forth in the medical insurance policy if filing on behalf of the covered person. If filing on your own behalf, you need to submit your written request within the time frame established by applicable state law. Please submit the appeal online via Availity Essentials or send the appeal to the following address:

Humana Grievances and Appeals
P.O. Box 14546
Lexington, KY 40512-4546

In Puerto Rico, please use this address:

Humana Inc.
Unidad de Querellas y Apelaciones
P.O. Box 191920
San Juan, PR 00919-1920

Please include with your request:

  • A copy of the original claim (For Availity Essentials submissions, claim details are automatically uploaded.)
  • The explanation of remittance (EOR) showing the denial
  • Any clinical records and other documentation that support your case for reimbursement
  • An Appointment of Representative form or other legal documentation authorizing you to act on the covered person’s behalf (if you are filing an appeal on behalf of a covered person)

Please note that the commercial plan appeals process is the same for nonparticipating and participating providers.

Medicaid plans: reconsiderations for nonparticipating providers

If you believe the determination of a claim is incorrect, please review your state laws and/or the applicable provider resources, linked below, for reconsideration rights. The reconsideration request will be reviewed by parties not involved in the initial determination.

To request a reconsideration, you need to submit your request in the applicable time frame specified in state law. This request should include:

  • A copy of the original claim (For Availity Essentials submissions, claim details are automatically uploaded.)
  • The remittance notification showing the denial
  • Any clinical records and other documentation that support your case for reimbursement
  • Any other documents as required by applicable state law or procedures

Reconsideration requests containing the documents listed above should be submitted online via Availity Essentials or mailed to the appropriate P.O. box. For more information and mailing addresses, please see the following state-specific resources for Medicaid/dual plans:

Florida
Illinois
Kentucky
Ohio
South Carolina