Humana Healthy Horizons® in Kentucky is more than a health plan. We are committed to providing what you need to give our enrollees the best care possible. Humana Healthy Horizons features great medical benefits and more, including our Go365 for Humana Healthy Horizons® rewards program, expanded vision services, childcare assistance, and helpful digital tools to help enrollees better manage their health.
Humana contracts with the Kentucky Cabinet for Health and Family Services to provide services to Medicaid enrollees through Humana Healthy Horizons. Medicaid provides healthcare coverage for income-eligible children, seniors, disabled adults, pregnant women, and other eligible adults. It is funded by both the state and federal governments.
Humana medical coverage policies are available on Humana.com, opens new window. Humana uses nationally recognized medical necessity guidelines (e.g., Milliman Care Guidelines [MCG] and American Society of Addiction Medicine® criteria). Criteria are readily available for review by Kentucky Department for Medicaid Services (Kentucky DMS), practitioners, the public, or enrollees on request at no cost. MCG guidelines are available either verbally or in writing on request. For providers and practitioners, the process to obtain criteria is communicated annually in the provider newsletter and provider manual.
Managed Care Organization (MCO) provider forums are returning to the Commonwealth.
We’re excited to announce the return of provider forums this year. We look forward to you and members of your staff joining us for the forums, which are scheduled for:
- Tuesday, April 11, 2023: Capital Plaza Hotel | Frankfort, KY
- Tuesday, April 18, 2023: Lake Barkley | Cadiz, KY
- Wednesday, April 19, 2023: Owensboro Convention Center | Owensboro, KY
- Thursday, April 27, 2023: Jenny Wiley | Prestonsburg, KY
- Tuesday, May 9, 2023: Hilton | Florence, KY
- Wednesday, May 10, 2023: Capital Plaza Hotel | Frankfort, KY
- Wednesday, May 18, 2023: Center for Rural Development | Somerset, KY
Register for one of the 2023 provider forums If you can’t make it, use the links below to access the resources available at the forums:
Access-to-care after-hours information, PDF
Access-to-care behavioral health information, PDF
Availity Essentials resources, PDF
Availity Essentials self-service resources, PDF
Communicating with enrollees with limited English proficiency, PDF
Housing information, PDF
HumanaBeginnings™ provider reference guide, PDF
PT/OT/ST prior authorization presentation, PDF
Relias information, PDF
Social Determinants of Health (SDOH) Physician Quick Guide, PDF
SDOH enrollee information, PDF
Workforce Development information, PDF
Please email KYMCDPR@humana.com to connect with us anytime.
Kentucky DMS has issued updated prior authorization guidance.
Review prior authorization guidance
The COVID-19 pandemic caused enrollees to delay many elective procedures, including certain cancer screenings (e.g., colonoscopies). Please talk to your patients about health screenings that may be overdue as well as safety protocols your facility has in place.
Eligible enrollees 6 months old and older can earn $40 in rewards through Go365 for Humana Healthy Horizons® after submitting proof of a COVID-19 vaccination. Learn more , opens new window.
Don’t forget that well-being visits can occur in-person or during a telemedicine visit. Feel free to pass along a reminder to your patients’ caregivers if you offer this service. Many well-being visits and screenings were delayed due to the COVID-19 pandemic. If a patient has an overdue screening or visit, please try to reschedule.
Qualifying enrollees with type 2 diabetes can work with a health coach through Vida Health. Visit Vida Health, opens new window or call 855-910-1215 (TTY: 711) to learn more. To refer a patient you believe could benefit from this program, call 855-910-1215 (TTY: 711).