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Payer playbook · National

Humana

Humana Insurance Company / Humana Health Plan, Inc. · Humana Inc. · NAIC 73288

01

Where to send the appeal

Verified addresses and inbound channels. We refresh on every release.

Fax
+1-800-949-2961
Provider portal
https://www.humana.com/provider/medical-resources/claims-payments/disputes-appealsaccepts appeals
Mailing address
Humana — Provider Payment Integrity Dispute Department P.O. Box 14546 Lexington, KY 40512-4546
02

Response timeline

The clocks that matter. Miss them and you escalate to the state insurance commissioner.

First-level response
60 days
Second-level response
60 days
Provider appeal window
365 days
Expedited pathway
72 hours
03

Codes worth fighting

Based on outcome data across our payer corpus.

Known win codes
  • CO-97
  • CO-18
  • PR-2
  • CO-4
  • CO-167
Known difficult codes
  • CO-50
  • CO-29
  • PR-1
04

Modifier behavior

The denials this payer applies on modifier-bearing claims. The rebuttal language is part of the Denial OS letter generator and not published here.

Modifier 25

Significant, Separately Identifiable E/M Service

Humana applies CMS-aligned edits on modifier 25 in Medicare Advantage; commercial products show similar patterns.

Recommended rebuttal language is part of the Denial OS letter engine — start a free appeal to see it in context.

Modifier GA / GZ

Advance Beneficiary Notice (ABN) modifiers

Common in Medicare Advantage when ABN was missing or improperly executed. Often denied with no recourse.

Recommended rebuttal language is part of the Denial OS letter engine — start a free appeal to see it in context.
05

Interest statute

The legal basis for charging interest when payment runs late.

Medicare Advantage: 42 CFR 422.520(a) prompt payment / state prompt-pay statutes for commercial products / federal floor under ACA §2719 / 45 CFR 147.136 for non-grandfathered plans

You have the playbook. Now write the letter.

Paste your EOB and Denial OS generates the appeal in five minutes — citing the contracted rate, the modifier rebuttal, and the deadline statute that matches this exact payer.

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