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

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Humana Healthy Horizons in Virginia

Providers who care for Virginia Cardinal Care members with coverage through Humana Healthy Horizons® in Virginia can submit paper claims through the mail or electronic claims through their secure Availity Essentials account.

Paper claims should be mailed to:

Humana Claims
P.O. Box 14359 
Lexington, KY 40512-4601

For electronic claims, sign in to your Availity Essentials account and select the Humana Medicaid payer ID (61101 for fee-for-service claims) from the Payer drop-down menu before submitting.

Humana Healthy Horizons ensures their compliance target and turnaround times for electronic claims to be paid/denied comply within the following time frames:

Humana pays 90% of all clean claims submitted from providers within 30 calendar days from the date of receipt.

Humana pays 99% of all clean claims from providers within 90 calendar days of the date of receipt.

For all submitted claims, both paper and electronic, Humana Healthy Horizons issues payment within 30 calendar days of receipt of a clean claim, in which all requested documentation is provided, in the proper format, and does not contain any material defect, error or impropriety.

Working with Humana Healthy Horizons

Below we include information about electronic fund transfers, out-of-network claims, payment integrity, overpayments and disputes. If you have any questions, or need other information, contact Provider Services at 844-881-4482 (TTY:771). Monday – Friday, 7 a.m. – 7 p.m. Eastern time

Get paid faster

Get paid faster and reduce administrative paperwork electronic funds transfer (EFT) and electronic remittance advice (ERA). Healthcare providers can use Humana Healthy Horizons’ ERA/EFT enrollment tool on Availity Essentials to enroll. To access this tool:

Sign in to Availity Essentials (registration required).

From the Payer Spaces menu, select Humana.

From the Applications tab, select the ERA/EFT Enrollment app. (If you don’t see the app, contact an Availity administrator to discuss your need for this tool.)

When you enroll in EFT, Humana Healthy Horizons claim payments are deposited directly in the bank account(s) of your choice.

Claims Dispute Process 

If you are not satisfied with Humana’s decision to deny or reduce an authorization or reimbursement of a claim, you can file a provider reconsideration with Humana and an appeal with DMAS thereafter. 

There are two steps in the disputes process: 

Reconsideration: A reconsideration represents your initial request for an investigation into a reduced or denied authorization or claim reimbursement. Most issues are resolved at the reconsideration step. 

Informal and formal appeals via DMAS: This is the second step in the process. If you disagree with the outcome of the reconsideration, you may request additional types of reviews, known as formal and informal, and appeal directly to DMAS 

You have 60 days from receiving written notification of the denial or reduction of an authorization, or the denial or reduction of claim reimbursement, to submit a reconsideration request. Reconsideration requests are resolved within 30 days of receipt of the request. 

Reconsiderations can be submitted through Availity Essentials or mailed to: 

Humana Healthy Horizons in Virginia
Attn: Reconsideration request
P.O. Box 14359
Lexington, KY 40512-4359 

Managing overpayments online

If a provider identifies a claim that was overpaid, the overpayment should be reported and returned within 30 days of the payment identification. The overpayment application on the Availity Essentials portal can help you manage overpayments. You can: 

Manage overpayment documentation and maintain case histories electronically

Reduce overpayment resolution time by managing overpayment requests from multiple payers 

Request more information about or dispute an overpayment request. 

Sign up for notifications when you have an overpayment 

View overpayment inventory in real-time 

The overpayment application is in the Availity Essentials portal under the claims and payments section. If you do not see the application, ask your organization’s Availity administrator to grant you the “Claim Status” role. 

Humana Healthy Horizons provides written notice to the provider at least 30 calendar days before an adjustment for the overpayment is made. If a dispute is not received from the provider, adjustments to the overpayment are made on a subsequent reimbursement.

Refund checks for overpayments can be mailed to: 

Humana Healthy Horizons in VA
P.O. Box 931655
Atlanta, GA 31193-1655 

Submitting Claims

Virginia Medicaid