For Humana Medicaid (Healthy Horizons), initial claims must be filed within 365 days of the date of service in most states, with a 180-day window when Medicare is the primary payer. Humana Medicare Advantage uses the same 365-day CMS minimum. Humana no longer offers commercial employer or individual ACA plans as of 2024 — practices with legacy claims should act quickly on any outstanding CO-29 appeals within the 180-day appeal window.
Humana's 2026 Plan Landscape: What's Still Active
Understanding which Humana plans still exist is the first step — because the answer has changed significantly since 2023.
Humana announced its exit from all employer group commercial medical products in February 2023, with coverage fully discontinued by 2024. The company also exited the individual ACA marketplace years prior. As of 2026, Humana's active lines of business for which practices are actively billing are:
- Medicare Advantage (Part C) — Humana's largest product line, available in 46 states and Washington, D.C.
- Medicaid managed care (Humana Healthy Horizons) — active in select states including Florida, Virginia, Ohio, South Carolina, Louisiana, and Oklahoma
- Military health (TRICARE) — administered through Humana Military for Defense Health Agency
- Group retiree plans (EGWP) — employer group waiver plans for Medicare-eligible retirees
If you are still seeing Humana commercial remittances, those are likely from claims that predate the exit or from group retiree (EGWP) plans that follow Medicare-adjacent rules. Any outstanding CO-29 denials from legacy commercial accounts have a 180-day appeal window from the denial date — that clock has been running.
Commercial Exit Means Timely Filing Windows Are Closed
Humana's commercial employer plans were discontinued in 2024. If your AR contains Humana commercial CO-29 denials from 2023–2024, those appeals must be filed within 180 days of the denial notice. Many practices lost these claims by assuming the same 365-day window as Medicare Advantage. Check outstanding AR now.
Humana Medicaid (Healthy Horizons) Timely Filing Limits
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Humana Medicaid requires initial claims to be filed within 365 days from the date of service in most Healthy Horizons states, consistent with 42 CFR §447.45 federal minimum standards.
According to Humana Healthy Horizons' 2026 Claims Quick Reference Guide (Louisiana edition, January 2026), claims must be submitted within 365 days of the date of service. When Medicare is the primary payer and Humana Medicaid is secondary, the window shortens to 180 calendar days from the date of Medicare's Explanation of Benefits (EOB) — not from the service date.
Medicare-Primary COB Claims Use the EOB Date, Not the Service Date
If your patient has Medicare as primary and Humana Healthy Horizons as secondary, the timely filing window runs from the date on Medicare's remittance, not the service date. Attaching the Medicare EOB to the secondary claim is required documentation — missing it is the most common reason these claims auto-deny.
State-level Humana Medicaid contracts may specify different windows. The table below reflects confirmed timely filing windows for active Healthy Horizons states. Where state-specific data is not confirmed below, the 365-day standard applies unless your provider agreement says otherwise.
| Humana Healthy Horizons State | Initial Claim TFL | Medicare-Primary (COB) Window | Notes |
|---|---|---|---|
| Louisiana | 365 days from DOS | 180 days from Medicare EOB | Confirmed — 2026 Claims Quick Reference Guide |
| Florida | 365 days from DOS | 180 days from Medicare EOB | Florida AHCA managed care contract; verify per plan |
| Virginia | 365 days from DOS | 180 days from Medicare EOB | Virginia DMAS contract; verify per agreement |
| Ohio | 365 days from DOS | 180 days from Medicare EOB | Ohio Medicaid contract; verify per agreement |
| South Carolina | 365 days from DOS | 180 days from Medicare EOB | SC DHHS contract; verify per agreement |
| Oklahoma (SoonerSelect) | 365 days from DOS | 180 days from Medicare EOB | Oklahoma OHCA contract; verify per agreement |
Always verify your specific state Medicaid provider agreement. State contracts occasionally specify shorter windows, and Humana's state-level provider manuals are authoritative over the general 365-day standard.
Humana Medicaid Appeal Deadlines
For Humana Healthy Horizons, the appeal window and process are governed by 42 CFR §438 (federal Medicaid managed care regulations) and the specific state Medicaid contract. Two deadlines matter most.
Grievance and appeal filing: Most Humana Healthy Horizons states require providers to file a reconsideration or appeal within 90 calendar days of the denial date. Some states allow up to 180 days. Check your state-specific denial notice — the deadline is printed on the remittance.
State fair hearing: If Humana upholds its denial, providers in most states can request a state Medicaid fair hearing within the timeframe specified on the denial letter (typically 30–120 days depending on the state, governed by the state Medicaid agency, not Humana).
| Appeal Level | Filing Window | Humana Decision Timeline | Submission Method |
|---|---|---|---|
| Level 1 — Provider Reconsideration | 90 days from denial (most states) | 30 days standard | Availity Essentials or mail |
| Expedited Reconsideration | Request at time of denial | 72 hours | Phone + written follow-up |
| State Fair Hearing | Printed on denial notice — varies by state | State Medicaid agency controlled | State-specific process |
Submit Humana Medicaid reconsiderations through Availity Essentials or at resolutions.humana.com. For state-specific fair hearing addresses, refer to the denial letter.
Humana Medicaid Provider Services: Call 855-223-9868 (Healthy Horizons general line) or the state-specific number on your Provider ID card.
Humana Medicare Advantage Timely Filing
For Humana Medicare Advantage plans, the timely filing limit is 365 days from the date of service — the CMS minimum for all Part C plans under 42 CFR §422.
For complete Medicare Advantage-specific guidance — including CO-29 appeal procedures, the 65-day reconsideration window, proof-of-filing documentation requirements, and 2026 changes from Humana's MA market contractions — see the companion guide: Humana Medicare Advantage Timely Filing Limit 2026.
MA Reconsideration Window: 65 Days (Much Shorter Than Medicaid)
Humana Medicare Advantage reconsiderations must be filed within 65 calendar days of the denial notice — significantly shorter than the 90-day Medicaid window or the 180-day legacy commercial window. If you are billing both MA and Medicaid, track these deadlines separately.
Legacy Commercial and ACA Claims: What Still Applies
Humana discontinued its employer group commercial products in 2024 and exited individual ACA exchanges prior to that. However, practices may still have outstanding AR from that era.
For claims submitted to Humana commercial plans before the exit, the applicable timely filing window was 90 days from the date of service for most provider types under standard Humana commercial contracts. Some physician agreements specified 180 days. If your group had a longer window written into a specific contract, that contractual term governed.
For any remaining CO-29 denials from legacy Humana commercial plans:
- The appeal deadline is 180 days from the date on the denial notice
- Submit appeals to Humana Grievances and Appeals, P.O. Box 14546, Lexington, KY 40512-4546, or via resolutions.humana.com
- Required documentation: original claim, remittance showing CO-29 denial, and proof of timely original submission (clearinghouse 277CA report, certified mail receipt, or fax confirmation)
If you have unappealed Humana commercial CO-29 denials and the 180-day appeal window has already passed, those claims are generally unrecoverable without documented proof of extraordinary circumstances.
Legacy Commercial Denials Are Not Recoverable After 180 Days
Once the 180-day commercial appeal window closes, Humana will not reopen CO-29 denials under standard procedures. If you are auditing old AR, prioritize Humana commercial CO-29s dated within the past 180 days immediately.
Proving Timely Filing: Documentation Humana Accepts
A CO-29 denial is not appealable without documentation. Whether the claim is Medicaid, MA, or a legacy commercial plan, Humana's standard for proof of timely filing is the same.
Acceptable proof:
- Electronic submissions (preferred): A 277CA clearinghouse acknowledgment report showing the claim submission date within the filing window. This is the gold standard and should be archived for at least seven years.
- Portal submissions: A confirmation email or screenshot from Availity Essentials showing the submission date.
- Paper/fax submissions: A certified mail return receipt with postmark date, or a fax confirmation sheet showing the date, time, page count, and recipient fax number.
Retroactive eligibility exception: If the member's Humana coverage was applied retroactively after the service date, the filing window runs from the date eligibility was confirmed, not the date of service. Include the retroactive enrollment notice from Humana with the appeal.
COB delay exception: For claims where Humana is secondary and the primary payer's payment was delayed, the window runs from the date of the primary payer's EOB, not the service date. Attach the primary payer's remittance.
For more detail on building a CO-29 reconsideration package specific to Humana MA, see Humana Appeal Letter Template 2026.
Timely Filing by Plan Type: Complete Reference
The table below summarizes all current and legacy Humana timely filing windows in one place.
| Plan Type | Initial Claim TFL | CO-29 Appeal Window | Appeal Decision Time |
|---|---|---|---|
| Medicare Advantage (Part C) | 365 days from DOS | 65 days from denial | 30 days standard; 72h expedited |
| Medicaid — Healthy Horizons (most states) | 365 days from DOS | 90 days from denial | 30 days standard; 72h expedited |
| Medicaid — COB (Medicare primary) | 180 days from Medicare EOB | 90 days from denial | 30 days standard |
| Legacy Commercial Employer (pre-2024) | 90 days from DOS (contract may vary) | 180 days from denial | 30–60 days |
| Military / TRICARE (Humana Military) | Governed by TRICARE regulations | TRICARE appeals process | TRICARE-specific |
How Muni Appeals Helps with Humana Timely Filing Denials
Tracking multiple Humana plan types — each with different filing windows and appeal deadlines — requires consistent documentation at the point of claim submission, not after the denial arrives.
Muni Appeals supports the Humana denial workflow across plan types:
- Flags CO-29 denials from Humana Medicaid and MA remittances automatically
- Tracks the 90-day Medicaid and 65-day MA appeal windows per denial so nothing ages out
- Pulls 277CA confirmation data to attach proof of timely filing
- Generates Humana-specific reconsideration letters with the correct mailing addresses and documentation requirements
- Monitors reconsideration status through Availity
For practices still working through legacy commercial AR, Muni supports the appeal documentation workflow for any CO-29 denials still within the 180-day window.
Frequently Asked Questions
What is the Humana Medicaid timely filing limit in 2026?
Humana Healthy Horizons requires initial claims within 365 days of the date of service in most states, consistent with federal Medicaid managed care minimums under 42 CFR §447.45. When Medicare is the primary payer, the window is 180 days from the date of Medicare's EOB. Always verify your state-specific provider agreement, as individual state contracts may specify shorter windows.
Does Humana still offer commercial employer plans in 2026?
No. Humana exited the employer group commercial medical products business, with coverage fully discontinued in 2024 following the February 2023 announcement. Humana no longer offers commercial employer, individual, or ACA marketplace health plans. Its current under-65 insurance product is Medicaid managed care (Healthy Horizons) in select states.
What is the CO-29 denial code and how does it apply to Humana plans?
CO-29 is the standard Claim Adjustment Reason Code for timely filing denials — it means the claim was submitted after the contractual or regulatory deadline. For Humana MA, a CO-29 appeal must be filed within 65 days of the denial date. For Humana Medicaid, the appeal window is typically 90 days. For legacy Humana commercial plans (pre-2024), the appeal window was 180 days. In all cases, documented proof of timely original submission is required.
What is the Humana Medicaid appeal deadline?
For most Humana Healthy Horizons states, the provider reconsideration must be filed within 90 calendar days of the denial date. Some states allow up to 180 days. The exact deadline is printed on the denial notice — do not assume the MA 65-day window applies to Medicaid claims. Check the remittance for the plan type before calculating the deadline.
How does Humana handle COB claims where Medicare is primary?
When a patient has Medicare as primary and Humana Healthy Horizons as secondary, submit the claim to Humana Medicaid within 180 calendar days of Medicare's EOB date — not from the service date. Include a copy of Medicare's remittance as required supporting documentation. Missing the EOB attachment is the most common reason these secondary claims deny on timeliness.
Where do I submit a Humana appeal or reconsideration in 2026?
Submit reconsiderations online at resolutions.humana.com or through Availity Essentials. For mail submissions, send to: Humana Grievances and Appeals, P.O. Box 14546, Lexington, KY 40512-4546. For Medicaid-specific appeals, use the address on the state-specific denial notice, as some Healthy Horizons states use separate mailing addresses. Call 855-223-9868 for Medicaid provider services or 800-457-4708 for MA provider support.
How do I prove timely filing to Humana?
The strongest documentation is a 277CA clearinghouse acknowledgment report showing a submission date within the filing window. For Availity portal submissions, a confirmation email or screenshot showing the filed date is acceptable. For fax or mail, use a fax transmission report with date/time/page count, or a certified mail return receipt with postmark. Store 277CA reports for at least seven years — many practices only keep them 90 days and lose the ability to appeal CO-29 denials.
Is the timely filing limit the same across all Humana Healthy Horizons states?
Not necessarily. The 365-day window is confirmed for Louisiana and appears to reflect the federal Medicaid minimum applied across most Healthy Horizons states. However, individual state Medicaid contracts can specify shorter windows. If you are billing in a specific Healthy Horizons state, review your state's provider agreement or call Humana's state-specific provider line to confirm the exact window before billing.
Ready to Stop Losing Revenue to Humana Timely Filing Denials?
CO-29 denials across Humana's plan types — Medicaid, Medicare Advantage, and legacy commercial — each have distinct windows, distinct appeal processes, and distinct documentation requirements. Missing one is a recoverable mistake only inside the appeal window.
Get Started:
- Automated CO-29 detection from Humana Medicaid and MA remittances
- Per-claim deadline tracking (90-day Medicaid, 65-day MA, 180-day legacy commercial)
- Humana-specific reconsideration letters with correct mailing addresses
- Proof-of-filing documentation compiled automatically
- Status tracking through Availity for all active appeals
This guide reflects 2026 Humana timely filing policies based on Humana's published provider portal guidance, the 2026 Humana Healthy Horizons Claims Quick Reference Guide, and federal Medicaid managed care regulations under 42 CFR §447.45 and §438. State-specific Medicaid contracts may specify shorter filing windows — verify your state agreement before relying on the general deadlines above. Humana's Medicare Advantage timely filing rules follow CMS Part C regulations. For Humana MA-specific appeal procedures and the CO-29 reconsideration workflow, see our Humana Medicare Advantage Timely Filing Limit 2026. For Humana denied claim guidance, see our Humana Denied Claim Guide 2026.