You have the right to file a grievance or appeal with Humana Healthy Horizons^® in Kentucky regarding a healthcare service, claim for reimbursement, provider payment or contractual issue. After receiving your grievance or appeal, we will review and respond with the results of our review or ask for additional information.

If your claim denial was for no authorization on file and you’d like to pursue requesting a retroactive authorization, read our  retrospective review policy  to see if you qualify. 

Grievances

We hope that you never have a grievance to report to us, but if you do, we want to hear about it and see how we can help.

A grievance is how a provider can notify us of dissatisfaction with anything other than an adverse benefit determination. For example, a provider can file a grievance because of processes/policies, claims processing (not an appeal), communications, fraud/waste/abuse or contracting/credentialing.

You must submit a grievance within 60 calendar days from Humana Healthy Horizons’ date of notice or action.

You can submit grievances by mail, phone or fax, or via your  secure Availity account . You may use the  Kentucky Medicaid MCO Provider Grievance Form .

Submit by mail:
Humana Healthy Horizons
Grievance and Appeal Department
P.O. Box 14546
Lexington, KY 40512-4546

Submit by phone:
800-444-9137

Submit by fax:
800-949-2961

Provider contracted rate disputes

A provider contracted rate dispute is considered a grievance. Use the provider  Contracted Rate Dispute Form  to let us know of payment errors specifically related to the provider contract. All other issues must be submitted via the provider appeals process.

Please reference the  Contracted Rate Dispute Process  for details on how to submit.

You must submit a Contracted Rate Dispute Form within 24 months of the original processing date of the claim in question.

You can submit contracted rate disputes by mail, fax or via your  secure Availity account .

Submit by mail:
Humana Healthy Horizons
Contracted Rate Disputes
P.O. Box 14546
Lexington, KY 40512-4546

Submit by fax:
800-949-2961

Appeals

An appeal is a request for review of an adverse benefit determination or payment denial decision by Humana related to covered services, services you provided or payment for a service. Providers have 60 calendar days from Humana Healthy Horizons’ date of notice or action or date of original claim submission denial.

You can submit appeals by mail, phone or fax, or via your  secure Availity account . You may use the Kentucky Medicaid MCO Provider Appeal Request Form.

Submit by mail:
Humana Healthy Horizons
Grievance and Appeal Department
P.O. Box 14546
Lexington, KY 40512-4546

Submit by phone:
800-444-9137

Submit by fax:
800-949-2961

External independent review

If you are not happy with our resolution of your appeal, you can request review by an external independent third party. When you request this type of review, an independent third party outside of Humana’s internal appeal process will review your appeal and supporting documentation. Providers have 60 calendar days from receipt of the appeal resolution to request a review by the external independent third party. You must submit a request for an external independent review in writing via mail, email or fax to Humana.

Submit by mail:
Humana Healthy Horizons
Grievance and Appeal Department
P.O. Box 14546
Lexington, KY 40512-4546

Submit by fax:
502-508-1796

Submit by email:
HumanaMedicaid_EIR_MFH@humana.com

For details and instructions on submitting this EIR form, please see Medicaid Provider External Independent Review (EIR) Intake Form Network Notice .

External Independent Review (EIR) Request Form .

Dental and vision grievances and internal appeals

You can submit dental and vision grievances (including contracted rate disputes) and appeals to Avēsis by mail or email, or via the  Avēsis provider portal .

Submit by mail:
Avēsis Third-Party Administrators, Inc. LLC
Attn: Complaint Appeals and Grievances
P.O. Box 38300
Phoenix, AZ 85069-8300

Submit by email:  ag@avesis.com

All external independent review requests must be submitted to Humana.