Claim Dispute Form for Humana Healthy Horizons Kentucky
This claim dispute form is essential for providers to submit disputes for incorrect payments, clinical edits, and more. It ensures a structured process for reviewing and resolving payment errors. Utilize this form to streamline your claims disputes with Humana Healthy Horizons in Kentucky.
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How do I fill this out?
To fill out this form, start by providing the patient and provider information in the designated fields. Next, select the appropriate claim dispute reason from the list provided. Finally, attach any necessary documentation to support your claim dispute for a thorough review.
How to fill out the Claim Dispute Form for Humana Healthy Horizons Kentucky?
1
Download the claim dispute form from the Humana Healthy Horizons website.
2
Fill in all required fields including patient, provider, and requestor information.
3
Select the claim dispute reason and provide a detailed description.
4
Attach any supporting documentation such as the explanation of payment.
5
Submit the form through the specified method provided in the instructions.
Who needs the Claim Dispute Form for Humana Healthy Horizons Kentucky?
1
Healthcare providers addressing payment discrepancies.
2
Billing specialists handling claims and disputes.
3
Administrators needing to resolve patient billing issues.
4
Patients who want to ensure their claims are processed correctly.
5
Insurance representatives validating claims for accuracy.
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1
Upload your claim dispute PDF to the PrintFriendly platform.
2
Use the editing tools to modify text or fields as needed.
3
Incorporate any additional information or notes relevant to the dispute.
4
Review your changes to ensure accuracy.
5
Download the edited PDF for submission.
What are the instructions for submitting this form?
To submit the claim dispute form, you can either use the online provider portal at www.humana.com/KentuckyMedicaid or mail it to Humana Healthy Horizons in Kentucky, Attn: Provider Correspondence, P.O. Box 14601, Lexington, KY 40512-4601. You can also fax the completed form to 1-800-949-2961. Be sure to attach all required documentation and review the form before submitting to avoid rejections.
What are the important dates for this form in 2024 and 2025?
Providers must keep track of the submission deadlines for claim disputes, which are within 24 months of the original claim adjudication date. The resolution of disputes is expected within 30 days of Humana Healthy Horizons receiving the submission. Stay updated on any changes in policy or process in 2024 and 2025.
What is the purpose of this form?
The primary purpose of this claim dispute form is to provide a structured channel for healthcare providers to officially challenge payment errors made by Humana Healthy Horizons. By documenting disputes accurately, providers can ensure that claims are reviewed fairly and efficiently, facilitating a quicker resolution process. This form ultimately supports better financial management and accountability in patient billing and claims processing.
Tell me about this form and its components and fields line-by-line.
- 1. Patient Information: Includes name, Humana ID number, and date of service.
- 2. Provider Information: Requires NPI, Tax ID, and address, plus the name as it appears on W-9.
- 3. Requestor Information: Details about the person submitting the dispute, including name and contact info.
- 4. Claim Dispute Reason: Select from reasons like incorrect payment, clinical edit, and more.
- 5. Brief Description: A space for a clear and concise explanation of the dispute.
What happens if I fail to submit this form?
Failure to submit the claim dispute form accurately can lead to delays in resolving payment issues. Incomplete submissions may be rejected, causing further frustration for providers. It is critical to follow all instructions and include necessary documentation to prevent complications.
- Incomplete Submission: If the submission lacks required fields or documentation, it will be rejected.
- Incorrect Information: Providing inaccurate data can lead to miscommunication and disputes.
- Delays in Processing: Failure to submit correctly may extend the dispute resolution timeframe.
How do I know when to use this form?
- 1. Incorrect Payments: Submit when a payment received does not match the expected amount.
- 2. Clinical Edits: If your claim was denied or adjusted due to clinical edits.
- 3. Timely Filing: When you were unable to submit timely paperwork due to unexpected issues.
Frequently Asked Question
What is the claim dispute form used for?
This form is designed for healthcare providers to dispute claims related to payment errors.
How do I access the claim dispute form?
You can download the claim dispute form directly from the Humana Healthy Horizons website.
What documentation do I need to submit with this form?
It is important to attach the explanation of payment and any relevant provider contract provisions.
Can I submit this form online?
Yes, you can submit the completed form through the provider portal or by mail.
How long do I have to submit a claim dispute?
Providers have 24 months from the original adjudication date to file a dispute.
How long will it take to resolve my dispute?
Humana will resolve disputes within 30 calendar days of receipt.
Do I need to submit corrected claims with this form?
No, corrected claims should follow a separate submission process.
How can I track the status of my dispute?
You can track the status through the provider portal after submission.
Is there a specific format for attachments?
Attachments must clearly support the claim dispute and be relevant to the case.
Can I fill out the form electronically?
Yes, the form can be filled out electronically using PDF editing tools.
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