Humana Medical Records Review Form. Resources for healthcare professionals who interact with Humana

Resources for healthcare professionals who interact with Humana`s provider payment integrity (PPI) unit, who work to ensure accurate claims payment. Healthcare providers who believe that an additional release authorization for this review is necessary should obtain from Humana members their authorization for release of the medical Information for physicians, hospitals and other health care providers about medical claim payment reconsiderations and member appeals. The document is a medical record review form that contains criteria to evaluate whether a patient's medical records meet documentation If Humana or its designee is still unsuccessful at scheduling a date for the post-payment on-site review after these attempts, a denial for lack of medical records may be issued for all review . Please complete and attach this form to your formal letter of dispute to ensure your documentation is routed appropriately. Humana Military claims Attn: Medical records review PO Box 202157 Florence, SC 29502-2157 Durable Medical Equipment (DME) and Certificates of Medical Necessity (CMN) DME is a – View the medical record review dispute (inquiry) policy and link to the medical record review dispute (inquiry) form. Choose the category that best Follow any written instructions you receive for disputes on medical record reviews. For all other PPI inquiries about overpayment-related items or escalated concerns, follow the instructions Medical records from the ordering physician, as well as the requisition form and lab results, are necessary to complete a full and fair review of the pathology claim. Phone claim-payment inquiry: Call Humana’s provider call center at 800-448-6262. – View information regarding general inquiries and the escalation Follow the guidance below to submit Provider Payment Integrity (PPI) inquiries about medical record review disputes and other concerns, such as recoupment due to overpayments, Humana Provider Payment Integrity general inquiries and escalation process Follow the guidance below to submit Provider Payment Integrity (PPI) inquiries about medical record reviews, such X-ray/lab/imaging: Record should show documentation of X-ray, lab, imaging or other studies ordered. Sign in to Availity Essentials and select the Humana tile under Payer Spaces. Please note that this Healthcare providers can submit requested documentation to Humana via mail, fax, upload or an electronic medical records system. For faster adjudication of claims, the requested information Follow the guidance below to submit Provider Payment Integrity (PPI) inquiries about medical record reviews, such as medical record requests and recoupment due to overpayment, or to Submission option details for healthcare providers to manage and respond to a Humana request for medical records, itemized bills, and invoices. File results in the medical record with the primary care physician’s initials, thereby • You can submit medical documentation for reconsideration, without a corrected claim, even if there are no more specific diagnoses available for a corrected claim Table of contents Eligibility and Benefits Authorizations and Referrals Clinical Policies and Documentation Medical Claim Policies and Code Editing Medical Claim Submission Medical Provider Payment Integrity (PPI) Medical Record Review Dispute Request Form Please complete and attach this form to your formal letter of dispute to ensure your documentation is routed Find all the Medicaid documents and forms you need to stay organized including member handbooks, provider directories and Please attach copies of any supporting information or documents that we should review, such as receipts for medications or services already paid for, medical records, or a letter from your For retrieval, findings questions, or anything else related to medical record requests, please call the phone number located on the request letter you received. Be sure to include the original Medical Record Review Initial Findings Whether you're a Humana Medicare member or you get insurance from your employer, you have easy access to documents and forms. Learn where to submit disputes. Humana (or its designee) conducts post-payment reviews of healthcare providers’ records related to services rendered to Humana members. During such reviews, the healthcare provider is Policy details concerning disputes of medical record review findings made by Humana Provider Payment Integrity (PPI). Our representatives are trained to answer many of your claim questions and can initiate contact To submit medical records requested by Humana’s PPI team, submit through Availity Essentials.

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