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:
- Sign in to Availity Essentials (
registration required ) - 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.
- You can submit the appeal or dispute to Humana immediately or wait until later and submit it from your appeals worklist.
- 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
Information for participating providers
Participating providers may find the reconsideration processes in the
Information for nonparticipating providers
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
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
Payment integrity & disputes
Payment integrity & disputes Medical record dispute Medical record review Medical record management Prepayment review Postpayment review Medical records requirement Technical denial policy - Appeals and grievances