Provider documents & resources

These documents apply to all counties in Kentucky.

2021 Humana Healthy Horizons in Kentucky Provider Resource Guide, PDF opens new window

2021 Humana Healthy Horizons in Kentucky Provider Manual, PDF opens new window

2021 Humana Healthy Horizons in Kentucky Enrollee Handbook, PDF opens new window

Behavioral health after-hours availability information, PDF opens new window

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

Preauthorization for Advanced Imaging Services, PDF opens new window

Medicaid Prior Authorization and Notification List, PDF opens new window

Provider Resource Guide - Transition Details, PDF opens new window

Referral to Medicaid Case Management Form, PDF opens new window

Value Added Services Provider Guide , PDF opens new window

Moms First Provider Reference Guide, PDF opens new window

Pacify Smartphone App Provider Information, PDF opens new window

Moms First StrongWell Services Provider Information, PDF opens new window

Pharmacy Resources

Effective July 1, 2021:

We are partnering with one pharmacy benefit manager (PBM), MedImpact, for pharmacy claims processing and pharmacy prior authorizations.

All outpatient drugs, including over-the-counter (OTC) drugs, will be covered under a single Kentucky formulary and Preferred Drug List (PDL) that MedImpact will manage. This does not include physician-administered drugs, which we will continue to manage under our enrollees’ medical benefits.

If an enrollee uses medication that currently does not require prior authorization (PA) but will require a PA on and after July 1, 2021, the enrollee will be granted 90 days to transition to a preferred alternative or request a PA.

View a list of preferred drugs covered under the KY PDL, opens new window.

MedImpact will manage all PAs. To submit a PA request:

  • Call MedImpact at 844-336-2676
  • Fax 858-357-2612
  • Do so online through Cover My Meds, Surescripts, or CenterX ePA portals

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

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

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

Please use the Kentucky Medicaid Pharmacy Prior Authorization Form, PDF opens new window when submitting a prior authorization request.

Kentucky Medicaid Maximum Quantity List, PDF opens new window

Kentucky Medicaid Single Preferred Drug List, PDF opens new window

Kentucky Medicaid Single PDL Prior Authorization Criteria, opens new window

Pharmacy and Therapeutics Information, PDF opens new window

Pharmacy Claims Submission Guide, PDF opens new window

Pharmacy Quick Reference Guide, PDF opens new window

2021 Preferred Drug List - English, PDF opens new window

2021 Preferred Drug List - Spanish, PDF opens new window

Over-the-counter drug list, PDF opens new window

Forms

Abortion Consent Form, PDF opens new window

Claim Dispute Form, PDF opens new window

Notification of Pregnancy Form, PDF opens new window

Early elective deliveries (EEDs)

EEDs prior to 39 weeks gestation_06232017, PDF opens new window

Addendum to EEDs prior to 39 weeks gestation_06232017, PDF opens new window

The American College of Obstetricians and Gynecologists Patient Safety Checklist, PDF opens new window

Hospice Consent Form, PDF opens new window

Provider Grievance Form, PDF opens new window

Hysterectomy Consent Form, PDF opens new window

Sterilization Consent Form, PDF opens new window

Diabetes Management

As of Jan. 1, 2021, Vida Health offers free personalized health coaching to our enrollees 18 or older who have type 2 diabetes and who 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
  • Set up visits with their health coach
  • Use video, phone or text to visit with their health coach
  • View tips and videos customized to their health needs
  • And more

Visit Vida.com/HumanaKentucky, 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

Pacify

Humana Healthy Horizons in Kentucky now offers access to Pacify memberships.

Pacify is a smartphone app that connects pregnant enrollees and new moms to:

  • Pacify Lactation Consultants: Available 24/7 via video to offer breastfeeding support and answer other feeding-related questions
  • Humana Healthy Horizons in Kentucky Nurse Line: Available 24/7 via a phone call through the app to help if our enrollees or their babies are not feeling well
  • Humana Healthy Horizons in Kentucky Enrollee Services: Available via phone Monday through Friday, from 7 a.m. to 7 p.m. Eastern time via a phone call through the app, to help with benefits, finding a doctor and/or scheduling an appointment
  • Behavioral Health Crisis Line: Available 24/7 via a phone call through the app to help with behavioral health
  • Smoking-cessation Coaches: Available via a phone call through the app Monday through Friday, from 8 a.m. to 6 p.m. Eastern time, to help our enrollees quit smoking

Enrollees can call as often as they need support and do not need to make an appointment with Pacify. To register, enrollees can use the self-guided Pacify registration process, opens new window.

To find out more about the resources we offer our pregnant enrollees and new moms, please visit Humana.com/KentuckyMoms, opens new window.

Virtual care (telemedicine) services with MDLIVE®

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

While enrollees can access this service, we reinforce with them there are instances when they should receive in-person care from their primary care provider and/or a specialist, and when a visit to a retail clinic, urgent care center or emergency room may be 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.com/HumanaMedicaid*, opens new window, create an account, and connect with a doctor
  2. Call 844-403-0556 (TTY: 711), 24 hours a day, seven 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 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 Availity Portal, PDF opens new window

The links below may 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