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If you’re unhappy with any aspect of your medicare, medicaid or. Fax or mail the form. Web submit appeals and disputes online. Web complaints, appeals and grievances. Web online request for appeals, complaints and grievances. Web when a provider is submitting an appeal on behalf of a member, an appointment of representative form is required. Web grievance/appeal request form you may complete the form with information about the member whose treatment is the. Appeals and disputes for finalized humana medicare, medicaid or commercial claims can be. Get details on how to request preauthorization for various tests and procedures, view online. Download a copy of the following. Web appeal, complaint or grievance form if you have a complaint or appeal related to your humana plan or any aspect of your care,.