Where Do I Submit or Send Paper Claims for Services Provided?

Paper claims can be sent to:
P.O. BOX 195560
San Juan, PR 00919-5560

You can visit us at:
Ángel Ramos Foundation Building,
3rd floor
383 F.D. Roosevelt Ave
San Juan, Puerto Rico

You can visit us at the Mailing Room, Monday through Friday from 7:30 a.m. - 4:30 p.m.

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How Can I Request a Payment History?

You can request a payment history by calling Provider Service at 1-800-611-1474 or through Availity.com (registration required).

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How Can I Submit an Adjustment?

To request an adjustment and reconsideration of a bill, you must complete the Adjustment Request Form in its entirety without making any modifications. The adjustment request should correspond to claims that have not been processed for payment or have discrepancies. It must include any requested documentation and/or the necessary evidence for the reconsideration of your claims.

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What Should I Do to Receive Payment via Direct Deposit?

If you are interested in enrolling in direct deposit, you must follow the steps outlined in the following link: Direct Deposit Manual.

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Where Do I Submit Mental Health Service Claims?

You can submit mental health service claims to:

APS Healthcare Puerto Rico, Inc.
Claims Department,
P.O. Box 71474
San Juan, PR 00936-8574

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Where do I submit dental claims?

You can send dental claims to: NetClaim Solutions

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Where can I send the documents related to my tax withholding?

You can send your documents to: ContractLoadingTeam@humana.com.

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Where Can I Access Humana's Communications or Circular Letters?

You can access our list of circular letters and communications by clicking the following link: Provider Communications

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Where Can I Contact for Situations or Questions Related to Collections?

For collection situations or questions, you can call 1-800-438-7885. If you are not satisfied with the response provided during the call, you can send an email to HelpPPI@humana.com For more information, click the following link: Payment Integrity Resources.

Online Submission of Appeals or Disputes:
Appeals and disputes for finalized claims related to Humana Medicare, Medicaid, or commercial plans can be submitted through Availity’s secure provider portal, Availity Essentials. To get started:

1. Log in to Availity Essentials.
2. Use the Claim Status tool to locate the claim you wish to appeal or dispute, then click the Dispute Claim button on the details screen. This will add the claim to your Appeals worklist but will not send it to Humana.
3. Submit the appeal or dispute to Humana immediately or wait and send it later from your Appeals worklist.
4. To access your Appeals worklist at any time, navigate to Claims and Payments and then select Appeals.

Additional details can be found in Manage Claims, Appeals, and Online Disputes:

Availity Essentials Resources:

1. For training, visit: humana.com/providerwebinars
2. Find useful resources on how to use Availity’s tools and features by logging into Availity Essentials and utilizing the Help and Training menu located in the main navigation bar.
3. Get help with website technical issues by contacting Availity Customer Service at 800-AVAILITY (800-282-4548),
   Monday through Friday, from 8 a.m. to 8 p.m. Eastern Time.

Mail Submission of Claim Disputes

You can mail claim disputes to:

Humana Correspondence
PO Box 14601
Lexington, KY 40512-4601

Please ensure to include:

1. The healthcare provider’s name and Tax Identification Number.
2. Humana’s identification number for the covered affiliate and the relationship to the patient.
3. The date of service, claim number, and the name of the service provider.
4. The charge amount, actual payment amount, expected payment amount, and a description of your dispute.
5. Contact information for Humana’s response.

Claim Payment Inquiry by Phone:

Call Humana’s Provider Call Center at 800-448-6262. Our representatives are trained to answer many of your questions about claims and can initiate contact with other Humana departments when additional review or investigation is needed.

1. Note the reference number provided by the provider call center representative, as you will need it in the future.
2. If your issue is still pending and the call center representative has not adequately addressed it, you have the option to speak with a supervisor. The call center will contact you within 48 hours of your request.
3. In some situations, the call center representative will refer your inquiry or situation to an internal Humana team. If this occurs, you will receive a letter or an updated explanation from the Humana department completing the additional review/investigation. Most inquiries receive a response within 30 to 45 days. Please allow us time to properly investigate and resolve your inquiry before contacting us again.

If you are a participating provider and disagree with our determination after we respond to your initial submission online, by mail, or by phone, you may escalate your concern. Please follow these steps:

1. Note the reference number provided by the provider call center representative, as you will need it in the future.
2. If your issue is still pending and the call center representative has not adequately addressed it, you have the option to speak with a supervisor. The call center will contact you within 48 hours of your request.
3. In some situations, the call center representative will refer your inquiry or situation to an internal Humana team. If this occurs, you will receive a letter or an updated explanation from the Humana department completing the additional review/investigation. Most inquiries receive a response within 30 to 45 days. Please allow us time to properly investigate and resolve your inquiry before contacting us again.

If you are a participating provider and disagree with our determination after we respond to your initial submission online, by mail, or by phone, you may escalate your concern. Please follow these steps:

1. Send a secure Email to:
   HumanaProviderServices@humana.com.
2. Include the Claims Escalation Form:
   Attach the Claims Escalation Form with all necessary fields completed. Ensure you list all reference numbers, interaction numbers, or invoice numbers associated with previous attempts to resolve the inquiry.
3. Acknowledgment of Submission:
   Look for an email titled "Acknowledgment of Submission" with a tracking number within five business days after your submission.
4. Follow-Up Emails:
   After the acknowledgment, you will receive a follow-up email every 14 days.

Non-participating providers

Non-participating providers can find details on how to appeal determinations in Medical Claims Payment Reconsiderations and Appeals. Guide to resolving queries regarding claim payments

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Where Can I Send the Requested Medical Records?

Requested medical records can be sent by fax to 1-866-305-6655 or through the Availity Portal. After submitting the medical record, if you disagree with the response, you can submit an appeal by faxing to 1-888-815-8912. For more information, please click the following link: Payment Integrity Resources

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