Provider documents and resources

These documents and resources apply to all counties in Kentucky.

Access material health documents and resources

Provider manual

2023 Humana Healthy Horizons in Kentucky provider manual – effective March 15, 2023, PDF

2022 Humana Healthy Horizons in Kentucky provider manual – effective June 16, 2022, PDF

Resource, reference, and billing guides

Humana Healthy Horizons in Kentucky Provider Resource Guide, PDF

Enrollee Handbook

2024 Humana Healthy Horizons in Kentucky Enrollee Handbook, PDF

Access our online Find a Doctor service

Additional information

Behavioral health after-hours availability information, PDF

Medicaid Prior Authorization and Notification List, PDF

Mental Health Resources for Teens and Young Adults English, PDF

Mental Health Resources for Teens and Young Adults Spanish, PDF

Non-discrimination, cultural competency, language proficiency, and Americans with Disabilities Act (ADA) information, PDF

Preauthorization for advanced imaging services, PDF

Primary care provider and specialist after-hours availability information, PDF

Evidence-based practice surveys

Evidence-based practice survey for non-group providers

Evidence-based practice survey for group/facility providers

Pharmacy resources

MedImpact is the pharmacy benefit manager (PBM) for all pharmacy claims processing and pharmacy prior authorizations (PAs).

All outpatient drugs, including over-the-counter drugs, are covered under a single Kentucky Preferred Drug List (PDL), also known as a formulary, managed by MedImpact. This does not include physician-administered drugs, which we continue to manage under our enrollees’ medical benefits.

View a list of preferred drugs covered under the KY PDL, PDF.

MedImpact manages all PAs. To submit a PA request:

  • Call MedImpact at 844-336-2676
  • Fax 858-357-2612
  • Use the CoverMyMeds®, Surescripts®, or CenterX® ePA online portals

For all medically billed drug (J-code) PA requests, please continue to send those directly to us for review.

Please submit all claims with a date of service prior to July 1, 2021, to Humana Healthy Horizons® in Kentucky.

Please submit all claims with a date of service on and after July 1, 2021, to MedImpact.

Please use the Kentucky Medicaid Pharmacy Prior Authorization Form, PDF when submitting a PA request.

For pharmacy and therapeutics, go to Pharmacy and therapeutics information and select the “Committees” drop-down menu and then select “P&T.”

Kentucky Medicaid Maximum Quantity List, PDF

Kentucky Medicaid Single Preferred Drug List, PDF

Kentucky Medicaid Single PDL Prior Authorization Criteria, PDF

Pharmacy Quick Reference Guide, PDF

Preferred Drug List

Over-the-counter drug list, PDF

Forms

Kentucky Physicians Certification Statement of Medical Necessity for Non-Emergency Ambulance Services, PDF

Claim Dispute Form, PDF

Hospice Consent Form, PDF

Hysterectomy Consent Form, PDF

Incarceration Status Correction Form, PDF

Notification of Pregnancy Form, PDF

Provider Grievance Form, PDF

Referral to Medicaid Case Management Form, PDF

Use the below sample coordination of care letter when providing behavioral health updates to PCPs.

Sample coordination of care letter, PDF

Diabetes management

Vida Health offers free personalized health coaching to our enrollees 18 or older who have type 2 diabetes and are not currently working with a Humana Care coach.

Through Vida Health, eligible enrollees can:

  • Choose their own Vida Health coach (e.g., nutritionist, diabetes educator, etc.)
  • Monitor their health progress
  • Use video, phone or text to visit with their health coach
  • View tips and videos customized to their health needs

Visit Vida Health, opens new window to learn more. You also can call 855-910-1215 (TTY: 711) to refer a patient you believe could benefit from this program.

Kentucky Medicaid Diabetic Supplies Preferred Product List, PDF opens new window

Centers for Disease Control and Prevention (CDC) Hear Her campaign

The CDC launched recently an initiative called Hear Her™, which includes information, stories and resources for providers with pregnant patients in their panel. Learn how preventing maternal deaths and complications starts with listening.

CDC Hear Her campaign, PDF

HEDIS information

Access resources to help you meet Healthcare Effectiveness Data and Information Set (HEDIS®)* requirements.

Follow-up care for children prescribed attention-deficit/hyperactivity disorder (ADHD) medication (ADD), PDF

Metabolic monitoring for children and adolescents on antipsychotics (APM), PDF

Use of first-line psychosocial care for children and adolescents on antipsychotics (APP), PDF

Follow-up after hospitalization for mental illness (FUH), PDF

Follow-up after emergency department visit for mental illness (FUM), PDF

Diabetes screening for people with schizophrenia or bipolar disorder who are using antipsychotic medications (SSD), PDF

Cardiovascular monitoring for people with cardiovascular disease and schizophrenia (SMC), PDF

Diabetes monitoring for people with diabetes and schizophrenia (SMD), PDF

Antidepressant medication management (AMM), PDF

Follow-up after emergency department visit for alcohol and other drug abuse or dependence (FUA), PDF

Initiation and engagement of substance use disorder treatment (IET), PDF

Pharmacotherapy for opioid use disorder (POD), PDF

Follow-up after high-intensity care for substance use disorder (FUI), PDF

Virtual care (telemedicine) services with MDLIVE

Our enrollees can connect with doctors 24 hours a day, 7 days a week via virtual visits with MDLIVE®. All MDLIVE doctors are state-licensed, board-certified experts attending patients virtually.

While enrollees can access this service, we reiterate that there are instances when they should receive in-person care from their PCP and/or a specialist, and when a visit to a retail clinic, urgent care center, or emergency room (ER) is needed.

MDLIVE provides consultation and treatment for a variety of healthcare needs, including cold and flu symptoms, medication adjustments, prescription refills, and skin conditions, without having to see anyone in person.

To get care via MDLIVE, our enrollees can:

  1. Go to MDLIVE, opens new window*, create an account, and connect with a doctor
  2. Call 844-403-0556 (TTY: 711), 24 hours a day, 7 days a week
  3. Download* the MDLIVE mobile app from the App Store® or Google Play®

For more information about MDLIVE, please visit Humana.com/KentuckyVirtualCare, opens new window.

*Internet access required

Other resources

Availity Essentials® is a useful resource that allows healthcare providers to:

  • Check the status of a claim
  • File grievances and/or appeals
  • Submit inquiries
  • Submit supporting documentation

Availity, opens new window

How to register for the Availity portal, PDF opens new window

The following links provide additional guidance and information:

Kentucky Health Information Exchange (KHIE), opens new window

Cabinet for Health and Family Services (CHFS), opens new window

Department for Medicaid Services (DMS), opens new window

Credentialing verification, opens new window

Provider relations representative assignments

Provider relations representative assignment list, PDF opens new window

Provider relations representative assignment map by county , PDF opens new window