You have the right to appeal any decision not to provide you or pay for an item or service (in whole or in part). To get more information about appeals (including status updates), grievances, or questions please contact Humana’s Customer Care Specialists at 1-800-448-6262. Cohere is unable to discuss determination details over the phone.
For both lines of business, you can submit an appeal with Humana immediately after a Cohere denial has been issued.
Please review the details below to learn more about the appeal process and timeline and click here to print these details.
How To Submit Appeals
|Line of business||How to submit||Appeal window|
|Medicare||Must be submitted by mail, fax, or phone||Within 60 days of receiving the denial letter|
|Commercial||Must be submitted in writing||Within 180 days of receiving the denial letter|
*If you are outside the appeal window you may not appeal and therefore must submit a new request to Cohere.
Send written appeals to Humana:
Grievance and Appeal Department
P.O. Box 14546
Lexington, KY 40512-4546
Re-submitting to Cohere
When re-submitting a request to Cohere, the following timeline and criteria must be followed:
*If the same request is submitted before day 61, that request will be voided as a duplicate.
**If there is no new information included with the re-submitted request, that request will be voided as a duplicate up until day 181.
Frequently Asked Questions
Q: Can you fax me a copy of the denial?
A: If a "denied" decision has been made, you are able to print a copy of the denial letter from within the Cohere portal by clicking the printer icon that appears on the authorization when hovering your mouse over the status.
Q: Who may file an appeal?
A: The requesting provider or someone named to act on their behalf with Humana may file an appeal. To appoint an authorized representative you must send a signed "Humana Appointment of Authorized Representative Form" with, or before, your appeal. Members may also initiate an appeal.