Contractual Requirement Reminder

Humana wants to remind all of its network physicians and providers to report any action that would have bearing or potential bearing on their ability to practice medicine.

Please note that all network physicians and providers have a contractual requirement to report actions such as license suspensions, restrictions, limitations and/or revocations. This includes any license revocation or suspension that is stayed.

In Humana’s Physician Administrative Manual (PAM), under the section entitled “Physician Responsibility,” it states that network physicians and providers must “inform Humana in writing within 24 hours of any revocation or suspension of his or her Bureau of Narcotics and Dangerous Drugs number, and/or suspension, limitation or revocation of his or her license, certification, Clinical Laboratories Improvement Amendment (CLIA) certificate or other legal credential authorizing him/her to practice in the state.”

Humana requires notification within 24 hours of a signed agreed order. Failure of the provider to furnish such notification to Humana within one week of any action constitutes failure to comply and could be grounds for termination of the provider’s agreement with Humana.

Any information about such actions should be sent to your local Humana credentialing department. The department can also answer any questions regarding contractual requirements.

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