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Join our network and find credentialing information.

Log in to Availity Essentials™ to access patient benefits, claims information and more.

Find tools and materials to support doing business with us.

Learn more about research and trends that impact your practice.

Find self-service info and phone numbers and update your provider data.

Review prior authorization lists for services, medications and submission guidance.

Prior authorization submission information

Professionally administered drugs prior authorization

Find appeals guidelines and payment policy information.

Learn how to submit claims and find coding guidance.

Find policies for procedures, devices and medications.

Review guidelines and health programs to support your patients and practice.

Find dental benefits, tools and resources.

Prior authorization for professionally administered drugs 

Locate state-specific resources for Humana Healthy Horizons® (Medicaid).

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Shop plans, learn about Medicare and explore member resources.

Search for in-network medical, vision, dental and pharmacy providers.

Humana provider payment integrity policies and processes

At Humana, we strive 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:

An issue regarding the coordination of member benefits

Medical record reviews

Member plan termination

Subrogation

Duplicate payments

Medical coding reviews

Incorrect provider reimbursement

Fraud, waste and abuse detection

Manage overpayments online

The overpayments application on Availity Essentials™ helps you manage overpayments. You can:

Reduce overpayment resolution time by managing overpayment requests from multiple payers in one app.

View overpayment inventory in real time and assign related tasks to specific users.

Manage overpayment documentation and maintain case histories electronically.

Sign up to be notified when you have a new overpayment.

Request more information about or dispute (or inquire) an overpayment request.

The overpayments application is located on Availity Essentials under “Claims & Payments.” If you do not see the application, ask your organization’s Availity administrator to grant you the “Claim Status” role.

Learn the key advantages and steps for getting started with the overpayments application in this informational flyer. 

How to dispute (or inquire) Humana’s overpayment findings

The most efficient way to dispute (or inquire) an overpayment is to use the overpayments application on Availity Essentials. To get started:

Access the overpayments application on Availity Essentials at www.availity.com under “Claims & Payments.”

In the application, click the action menu on the card for the overpayment you wish to dispute (or inquire).

Select “Dispute Overpayment.”

In the “Dispute Overpayment” window, select a dispute (inquiry) type and enter a description of the dispute (inquiry). You must provide a description of the dispute (inquiry).

Click “Submit.”

Alternatively, you can follow this dispute (inquiry) process:

To dispute (or inquire) a medical record review – View the medical record review dispute (inquiry) policy and link to the medical record review dispute (inquiry) form.

To resolve recoupment concerns – View information regarding general inquiries and the escalation process to resolve recoupment concerns, such as overpayments, financial recovery reviews, disputes (inquiries) and medical record requests.

Medical record review resources

These resources can help when you are interacting with PPI’s medical record review team.

PPI overpayment and recoupment

Once a claim has been identified as overpaid, Humana may send a written notice of overpayment within the applicable time frame for each of Humana's products. Humana follows state regulations, provider contract requirements and CMS provisions when processing overpayments and recoupments.

Subrogation, Medicare secondary payer, and other payer liability

Use the Injury Report and File Status Request to:

Report accidents

Confirm if Humana provided benefits for an accident-related injury or illness

Request final payment information needed to settle claims made against other insurance carriers and individuals

Once you have completed the request, please email a saved copy to SubrogationReferrals@Humana.com, or mail to:

Humana Subrogation and Other payer Liability
004/48110
P.O. Box 2257
Louisville, KY 40201-2257

If you have additional questions or need to supply additional information, please contact us.

Denial for Lack of Medical Records Policy

Subrogation, Medicare secondary payer, and other payer liability

Payment integrity & disputes