Humana CO-45 Fee Variance Payment Dispute
Charge exceeds fee schedule / contracted rate. Copy-paste appeal letter with documented overturn rate and attachment checklist for Humana.
Verify before filing
Filing deadlines, appeal addresses, and policy criteria in this template reflect typical payer behavior at publication. Humana updates policies frequently and plan-level rules vary by employer group, state, and line of business. Always cross-check the specific deadline and filing address on your EOB, and confirm current Humanamedical-policy language through the payer’s provider portal before submitting an appeal. Overturn-rate language below reflects AAPC-reviewer consensus, not payer-published statistics.
When to use this template
Most Humana CO-45 adjustments are valid contractual write-offs and should not be appealed. Investigate only when the variance is unexpectedly large, when the same CPT is paid different amounts on different claims, or when out-of-network fee schedules are applied to in-network claims.
Attachment checklist
- Provider contract excerpt with contracted rate
- EOBs for disputed claims
- Fee-schedule summary
Missing any one of these is the single largest cause of appeal denials. Build a pre-filing checklist before you submit.
Copy-paste letter template
Swap in your patient details at every [bracketed field]. Attach the documentation listed above. Submit within 180 days of the original adjudication.
[Payment Dispute - Not a Clinical Appeal] [Practice Letterhead] [Date] Humana Provider Relations / Contract Management Re: Payment Dispute - CO-45 Fee Variance Provider: [Practice Name, NPI, TIN] Contract: [Contract ID / Effective Date] Dispute Period: [Date range] CPT Codes Affected: [List] Dear Provider Relations: We are disputing the allowed amounts on the following claims where the CO-45 contractual adjustment appears inconsistent with our contracted rate with Humana. Contracted rate per contract dated [date]: CPT [X] = $[Y] allowable. Disputed claims: 1. Claim [#], DOS [date], Member [ID]: Allowed $[A] (expected $[Y], variance $[A-Y]) 2. [Repeat for each outlier claim] Root-cause analysis: [Identify the root cause, e.g. "Out-of-network fee schedule applied despite in-network status on the EOB"; "Case-rate contract not applied; claim paid per-procedure"; "Fee schedule not updated after contract renegotiation effective [date]"] Documentation attached: 1. Provider contract excerpt showing contracted rate for the CPT 2. EOBs for all disputed claims 3. Network-status verification from Humana provider enrollment We respectfully request review and reprocessing of these claims at the correct contracted rate. Sincerely, [Practice Administrator / Billing Manager Name] [Practice Name] [NPI, TIN] [Contact phone and email]
Investigate only when the CO-45 variance is unusually large or inconsistent across claims. Routine CO-45 adjustments are valid contractual write-offs and should not be appealed.
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Related templates
Same code, different payer. Or same payer, different problem
Common questions on this template
How long do I have to file a CO-45 appeal with Humana?
180 days from the initial adjudication date for most Humana plans. Corrected claims (for administrative fixes like missing modifiers or auth numbers) have a different and usually longer window. Always confirm the specific deadline on the EOB for your claim.
What is the typical overturn rate for this denial type?
Moderate to high when a documented contract-rate mismatch exists. Success depends heavily on documentation completeness and whether the clinical criteria in Humana's medical policy are matched point-by-point in the appeal.
Should I file this as a corrected claim or a formal appeal?
CO-45 denials are usually formal clinical appeals. The template below follows the formal-appeal structure. Use a corrected claim only if the fix is administrative (a missing modifier, wrong NPI) rather than clinical.
Can I reuse this template for other payers?
The structure works for any payer, but the filing address, deadline, and policy references are specific to Humana. Check our other templates for payer-specific versions; we have 50+ payer/code combinations in the directory.
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