Humana Provider Payment Integrity Medical Record Review Dispute Policy
This policy only applies to disputes concerning Humana Provider Payment Integrity’s (PPI) medical record review findings made during the adjudication of a claim or post-payment review of a claim. Humana offers health care providers up to three opportunities to dispute Humana’s medical record review findings (Levels One, Two and Three).i Dispute requests are reviewed by licensed or certified personnel different from the individuals who made the initial findings.
Please submit all levels of disputes to the following address:
Humana Provider Payment Integrity Disputes
P.O. Box 14279
Lexington, KY 40512-4279
To ensure proper routing and a thorough and timely review of your dispute, please include a copy of the completed Humana PPI Medical Record Review Dispute Request Form (link opens in new window) that was attached to the original findings letter and any other documentation related to your dispute.
Post-payment recoupment: If the initial findings letter describes an overpayment made to your facility, and you wish to avoid recoupment and dispute the initial findings, you must submit a formal, written Level One dispute letter along with all relevant documents within 75 calendar days from the date of the findings letter. If recoupment has not been initiated by the time we receive your dispute, the overpayment is placed on hold so that monies are not recouped or offset from future payments until the dispute process is completed.