We include below important information we want our providers to have. Check back often, as we update materials periodically during the year.
2023 Humana Healthy Horizons in Florida Provider Manual - effective October 1, 2023, PDF
2022 Humana Healthy Horizons in Florida Provider Manual – effective March 3, 2022, PDF
Refer to the Humana Healthy Horizons Provider Resource Guide for information about resources we make available to providers.
Humana Healthy Horizons in Florida Provider Resource Guide, PDF
Refer to the Humana Healthy Horizons in Florida Resource Guide for a list of departments and personnel that can assist with the coordination and authorization of services a patient in your panel with Humana Healthy Horizons coverage may need.
Humana Healthy Horizons in Florida Resource Guide, PDF
Claims processing updates for taxonomy and National Provider Identifier (NPI) requirements
The Agency for Health Care Administration (AHCA) released guidance about updates to the Provider Master List (PML) effective for dates of service starting March 1, 2022. Humana Healthy Horizons processes claims in accordance with this logic/guidance, generating denials when the appropriate taxonomy, ZIP code, or address information are not billed for providers with multiple active Medicaid IDs and specialties. We want to partner with you to assist in preventing future denials.
Claims processing updates for taxonomy and NPI requirements, PDF
Learn how to submit an American Rescue Plan Act (ARPA) Home- and Community-Based Services (HCBS) payment request
Humana Billing Rules for Medicaid, NPI, Taxonomy and Address Validation for Claims, PDF
Humana Healthy Horizons in Florida ARPA HCBS payment request information, PDF
Humana Healthy Horizons in Florida expanded benefits, PDF
Electronic visit verification (EVV) claims submission requirements - effective June 21, 2021, PDF
Expanded benefit – hepatitis A vaccine for adults coverage information, PDF
Humana Healthy Horizons in Florida Member Handbook, PDF
Access to care requirements for Humana Healthy Horizons in Florida members, PDF
For Pediatric Therapy access-to-care issues or complaints, please contact:
Theresa Bell
Humana - Senior Process Improvement Professional
Phone: 502-354-1364
Email: FLMedicaidResolution@humana.com
When one of your patients moves out of your service area
Please notify Humana Healthy Horizons if you become aware that one of your patients with Humana Healthy Horizons in Florida coverage moves out of your service area. Please complete this
notification form, PDF and send back by fax or email.
Humana Healthy Horizons in Florida network-contracted healthcare providers should use the Notification of Deceased Member Form to notify us when a member dies.
Notification for Deceased Member Form
, PDF
Health and dental plans are required to ensure continuity of care during the transition period for SMMC-enrolled Medicaid recipients. COC requirements ensure that members transfer without service lapse between health plans, service providers and service delivery systems (i.e., fee-for-service to managed care).
AHCA has instituted the following COC provisions:
- Healthcare providers should not cancel appointments with current patient
- For 60 days after the rollout date in each region, health plans must honor any ongoing treatment authorized prior to the recipient’s enrollment into that plan
Continuity of care provisions program highlights, PDF
Continuity of care information – SMMC plan website links, PDF
MMA Physician Incentive Program (MPIP) education materials
Humana MPIP Year 8 Plan Program Summary, PDF
Humana MPIP Year 7 Plan Program Summary, PDF
Humana MPIP Year 6 Plan Program Summary, PDF
Humana MPIP Year 5 Plan Program Summary, PDF
Humana MPIP Year 4 Plan Program Summary, PDF
Case management education materials and forms
Available Humana Healthy Horizons in Florida clinical programs, PDF
Controlling and managing sickle cell disease, PDF
Humana Healthy Horizons in Florida case management recommendations for Asthma, PDF
Humana Healthy Horizons in Florida Case Management recommendations for chronic obstructive pulmonary disease (COPD), PDF
Humana Healthy Horizons in Florida Case Management recommendations for heart failure, PDF
Humana Healthy Horizons in Florida Case Management recommendations for diabetes, PDF
Referral to Medicaid Case Management Form (all regions), PDF
Medicaid Preauthorization and Notification List (PALs)
Except where noted, prior authorization requests for medical services may be initiated:
- Online via Availity (registration required)
- By calling Humana’s interactive voice response (IVR) line 24-hours a day at 800-523-0023 (Humana Customer Care representatives are available Monday - Friday, 8 a.m. - 8 p.m. Eastern time)
NOTE: Online prior authorization requests are encouraged. Additionally, clinical information for a medical service preauthorization request may be faxed to 813-321-7220.
Except where noted, prior authorization requests for medications billed as medical claims may be initiated:
- By sending a fax to 888-447-3430 (request forms are available at Humana.com/medpa
- By calling 866-461-7273 (available Monday - Friday, 8 a.m. - 6 p.m. Eastern time)
Except where noted, prior authorization requests for durable medical equipment (DME) may be initiated:
- For regions 1–8: By calling 866-856-8974, the Humana clinical intake team, (available Monday - Friday, 8 a.m. - 5 p.m. Eastern time)
- For regions 9–11: By sending a fax to 855-441-6941 (One Homecare Solutions) or calling 855-441-6900 (available Monday - Friday, 8:30 a.m. - 9 p.m., and Saturday and Sunday, 9 a.m. to 5 p.m. Eastern time)
When asking us to authorize outpatient therapy, please complete and attach our Outpatient Therapy Authorization Request Form to your clinical documentation and signed plan of care.
Outpatient Therapy Authorization Request Form
, PDF
