HFS Complaint Tracking Process - Submitting and Disputing Complaints via Portal and Humana

Sep 15, 2026

Uploaded by James

Illinois HFS complaint tracking process effective at the beginning of 2020 requires a unique MCO tracking number for every Medicaid-related complaint submitted through the HFS Provider Portal, excluding Medicare. Providers must first attempt resolution via the MCO internal dispute/appeals process, then submit through the portal when needed. The document details Humana dispute submission for non-behavioral health claims, including Availity Essentials online steps, dispute worklist statuses, attachment rules, and how to obtain the MCO tracking number for follow-up.

LanguageEnglish

CategoryLetters

FormatPDF

Pages6

Reading Time2 min

AccessFree to download

HFS complaint tracking overview

Requirements for MCO tracking numbers and portal scope

Step 1: Use the MCO internal dispute/appeals process

Submitting disputes to Humana

Dispute pathways by service type

Non-behavioral health disputes - online submission

Availity Essentials registration and Claim Status workflow

Appeals worklist submission, statuses, and attachments

Dispute tracking number and final decision details

Non-behavioral health disputes - telephone submission

Non-behavioral health disputes - mail submission

Non-behavioral health disputes - fax submission

MCO tracking number format and how to retrieve it

HFS Complaint Tracking Process This document serves to provide additional and updated information regarding the Illinois Department of Healthcare and Family Services (HFS) complaint tracking process, which became effective at the beginning of 2020. Under the new process, HFS requires a unique Managed Care Organization (MCO) tracking number for every complaint submitted through the HFS Provider Portal. The HFS portal is for complaints relative to the Medicaid portion only, not Medicare. This also includes denials fora Medicare-covered service for dually eligible enrollees. To use the portal, providers or designated billing staff must first register with the portal at [https://hfs.illinois.gov/medicalproviders/cc/managedcarecomplaints.html](https://hfs.illinois.gov/medicalproviders/cc/managedcarecomplaints.html). HFS requires providers to first use the MCO internal dispute/appeals process to attempt to resolve a complaint before submitting a complaint through the portal. Provider disputes submitted to Humana If, upon receipt of an initial claim determination from Humana via Explanation of Remittance (EOR), Electronic Remittance Advice (ERA) or Remittance Advice, the provider disagrees with the determination made by Humana and would like to request a dispute, the providers may do so. However, the process and method to submit a dispute depends upon whether the dispute primarily involves behavioral health services. Non-behavioral health provider disputes Providers may submit disputes for non-behavioral health claims directly to Humana online, via telephone, mail or fax. Online 1. Sign in to Availity Essentials™ (registration required) . Note: If you don’t have access to the Claim Status tool, contact your organization’s Availity administrator to inquire about access. 2. Use the Claim Status tool to locate the claim you want to dispute, then select the Dispute Claim button on the claim details screen. This adds the claim to your worklist but does not submit it to Humana. 3. You can submit the dispute to Humana immediately or wait until later and submit it from your Appeals worklist. 4. To access your Appeals worklist at any time ‒ either to complete a submission or to check the status of prior requests submitted online ‒ from the Availity Essentials menu, go to Claims & Payments, and select Appeals. a. The Worklist dashboard will provide an overview of the claim appeal/dispute statuses. Any dispute with an “Initiated” status has not yet been submitted to Humana. 5. To submit the claim dispute from your Appeals worklist, navigate to the desired “Initiated” dispute, hover over the 3 black bars on the right side of the screen and select “Complete Dispute Request.” 6. Follow the steps to add the reason and rationale for the dispute, complete and attach required forms (if any), and attach supporting documentation. When finished, select the Submit Request button to submit your dispute to Humana. 7. The dispute status will now appear as “Submitted – Pending Assignment” within the worklist dashboard. a. Disputes can be in Pending Assignment status for up to 3 days, during which time additional attachments cannot be added. If you see an “Error: Resubmit” message next to an attachment, upload the file again once the dispute is no longer in pending status. 8. You will be able to see the dispute tracking number once the claim status changes to “In Progress” within the worklist dashboard: 9. The dispute status will change to “Finalized” once Humana has completed its review of the request, at which time Humana’s decision reason can be seen by selecting View Details and Attachments: Want help with online tools? • Working with Humana [online: Visit](online: Visit Humana.com/ProviderSelfService)[ ](online: Visit Humana.com/ProviderSelfService)[Humana.com/ProviderSelfService](online: Visit Humana.com/ProviderSelfService) • Humana training opportunities: Visit [Humana.com/ProviderWebinars](Humana.com/Pro

FAQs

What is the purpose of the Illinois HFS complaint tracking process effective in 2020?

It standardizes how complaints are tracked by requiring a unique MCO tracking number for each complaint submitted through the HFS Provider Portal for Medicaid-related matters.

Does the HFS Provider Portal cover both Medicaid and Medicare complaints?

No. The portal is for complaints related to the Medicaid portion only, not Medicare, including denials for Medicare-covered services for dually eligible enrollees.

What must providers do before submitting a complaint through the HFS portal?

Providers must first use the MCO internal dispute/appeals process to attempt to resolve the complaint before submitting it through the portal.

Sep 15, 2026

Uploaded by James