medical-records

Humana 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, invoices and other documentation via one of the following options:

  1. Upload the records to Humana’s Medical Records Management (MRM) tool.
    1. Log in to the Availity Portal at www.Availity.com (link opens in new window). (If you are not registered, select “Register” and complete the registration process to obtain a user ID and password.)
    2. From the top navigation bar, select “More,” then select “Medical Records Management” under the “Claims” heading.
  2. Mail the records to: Humana Medical Records Management, P.O. Box 14465, Lexington, KY 40512.
  3. Fax the records to 1-866-305-6655.

To ensure the medical records are indexed correctly, please attach the medical record request letter for each claim 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. You may leave a message 24 hours a day, seven days a week and provide the correct information. Please 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 Medical Records Management tool (see above) or by contacting the Humana PPI Customer Service Department at 1-800-438-7885. This line is open 24 hours a day, seven days a week.

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 the Humana PPI Customer Service Department for assistance. Please refer to the Humana Provider Payment Integrity Technical Denial Policy.

  1. Reimbursement for copying fees will be made at the contracted rate. If there is no rate specified in the provider's participation agreement or there is no contract, reimbursement will be made as follows: 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.