When submitting the appeal, please attach a copy of the refund request letter and a detailed explanation of why you believe we have made the refund request in error. Your appeal must be received within thirty (30) calendar days of the date of the refund request letter, or as required by law or your participation agreement, in order to allow sufficient time for processing the appeal, and to avoid possible offset of the overpayment against future claim payments to you. If you are disputing a refund request, please send your letter of appeal to the address noted on the refund request letter. Note: All proof of timely filing must also include documentation that the claim is for the correct patient and the correct visit.
HUMANA TIMELY FILING FOR APPEALS SOFTWARE
Paper claims – include a copy of a screen print from your accounting software to show the date you submitted the claim. Electronic claims – include confirmation that UnitedHealthcare or one of its affiliates received and accepted your claim.Ģ. If you are appealing a claim that was denied because filing was not timely:ġ. Our decision will be rendered based on the materials available at the time of formal appeal review. Include information which supplements your prior adjustment submission that you wish to have included in the appeal review. Attach all supporting materials such as member specific treatment plans or clinical records to the formal appeal request, based on the reason for the request. Your appeal must be submitted to us within twelve (12) months from the date of the adjustment decision shown on the Explanation of Benefits (EOB) or Provider Remittance Advice (PRA). Level 3: Expedited External, Independent Review If you still do not agree with the outcome of the Claim Reconsideration decision in Step 1, you may submit a formal appeal request to: The claim form should have the words “see attachment” in the “Member ID” box.If you believe you were underpaid by us, the first step in resolving your concern is to submit a Claim Reconsideration as described above. Physicians and health care providers may submit CMS 1500 forms or UB04 forms with an attachment listing multiple patients receiving the same service. Physicians and health care providers may submit multiple documents in a single large envelope.ĭocuments may include information regarding multiple patients. Physicians and other health care providers should follow the billing guidelines below when submitting roster bills to Humana:
When a claim is submitted in error to a carrier or agency other than Humana, the timely filing period begins as of the date the provider was notified of the error by the other carrier or agency.īilling guidelines for roster bills submitted on paper claims Generally, these claims must be submitted within:ġ80 days from the date of service for physicians.ĩ0 days from the date of service for facilities and ancillary providers. Medicare Advantage: Claims must be submitted within one calendar year from the date of service.Ĭommercial: Claims must be submitted within the time stipulated in the provider agreement or the applicable state law. Health care providers are encouraged to take note of the following claims submission time frames: Paper claim and encounter submission addresses
Valid National Provider Identifiers (NPIs) are required on all electronic claims and strongly encouraged on paper claims. Please keep in mind, however, that the claim or encounter mailing address on the member’s identification card is always the most appropriate to use. When it is necessary to submit paper claims, you can use the addresses below.
To decrease administrative costs and improve cash flow, clinicians and facilities are encouraged to use electronic claim submission whenever possible.
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