The appeal process is only applicable to charges denied as not covered or not medically necessary and are only accepted from appropriate appealing parties.
A proper appealing party is:
Note: A completed Appointment of Appeal Representative (AOR) form must be submitted with the appeal request. Appointed representatives MAY include:
Who cannot appeal:
Learn how to file an appeal with Humana Military
Appeals submissions:
HMHSRECON@humanamilitary.com (Preferred method)
Fax: (877) 850-1046
Humana Military Appeals
PO Box 740044
Louisville, KY 40201-7444
Appeal submission process FAQs
If a provider or a beneficiary has concerns about how a claim processed, an administrative review, also known as an allowable charge review, can be requested. It’s important to differentiate allowable charge reviews from medical necessity denial appeal requests.
Providers can submit a request for an administrative review when there are concerns about how a claim processed. The following are common reasons a provider may submit a request for administrative review: a request for administrative review, including:
Allowable charge appeals are processed by WPS.
Allow charge submissions:
Customer Service
TRICARE East Region
PO Box 8923
Madison, WI 53708-8923
Hours of operation: 8 AM to 7 PM ET
Phone: (800) 444-5445
Fax: (608) 221-7536
Participating providers may have claims reconsidered through medical review for issues including:
Claims reconsideration submissions:
Customer Service
TRICARE East Region
PO Box 8923
Madison, WI 53708-8923
Hours of operation: 8 AM to 7 PM ET
Phone: (800) 444-5445
Fax: (608) 221-7536
Electronic submissions
To ensure your electronic submission is processed in a timely manner, please confirm you are submitting the information in the correct portal, inbox or web form. To avoid additional delays, please only include details on a single beneficiary and to not combine requests.
Fax or mail submissions
TRICARE may ask for additional details, including for you to use the letter you received again as the coversheet for the information that you return. The letters, utilized as a coversheet, allow Humana Military to quickly document and identify beneficiaries via barcode and OCR recognition, speeding up the process.
To ensure your documentation is processed quickly, please send a single correspondence or fax with information regarding a single beneficiary. If multiple pieces of correspondence are mailed at the same time, they must be divided with coversheets.
Humana Military accepts HIPAA-compliant electronic faxes sent using HIPPA-compliant companies, such as UpDox, Faxage or SRFax, among others available through a web search.