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  • Humana Reconsideration Form

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COBRA Medical/Dental Benefits Election Form Subject to the terms stated in your Summary Plan Description, COBRA medical and/or dental benefits, may be available for you and/or your covered dependents.

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You must file an appeal within 60 days of the adverse benefit determination. An appeal may take up to 30 days to process. If you need us to expedite the grievance or appeal process, call us at 800-444-9137 (TTY: 711).

An appeal is a request for us to reconsider our decision. You must file an appeal within 60 days of the adverse benefit determination. An appeal may take up to 30 days to process. If you need us to expedite the grievance or appeal process, call us at 800-444-9137 (TTY: 711).

Yes! You can appoint a representative to appeal a denial on your behalf. To appoint a representative, complete the Appointment of Representative form and mail it to either your MAC (if you have Original Medicare) or your Medicare Advantage Plan.

To get started: Access the overpayments application on the Availity Portal at Availity.com under “Claims & Payments.” In the application, click the action menu on the card for the overpayment you wish to dispute. Select “Dispute Overpayment.”

Commercial: Claims must be submitted within 90 days from the date of service if no other state-mandated or contractual definition applies.

Include this information in your written request: Your name, address, and the Medicare Number on your Medicare card [JPG] The items or services for which you're requesting a reconsideration, the dates of service, and the reason(s) why you're appealing.

Time frames to submit a claim Commercial: Claims must be submitted within 90 days from the date of service if no other state-mandated or contractual definition applies.

Call Enrollee Services at 800-444-9137 (TTY: 711), Monday – Friday, from 7 a.m. – 7 p.m., Eastern time. We will get some information from you and start the appeal process. You still must send an official request for appeal to us in writing by: Completing a grievance or appeal form.

For technical help, call Availity Customer Service at 800-282-4548. For assistance with an issue related to a Humana overpayment, send an inquiry or message via the overpayments application.

If the claim can be corrected, a “Correct This Claim” button will display on the claim detail screen. Click the button, make corrections as needed and submit the correction. If provider uses a clearinghouse other than Availity Essentials: Submit your corrected claim through your clearinghouse that submits to CarePlus.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232