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Home / Coverage Claims / Payment Integrity / Reconsiderations and appeals for Providers

Appeals and grievances

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 flyer about online appeals.

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

Denial for Lack of Medical Records Policy

Payment integrity & disputes