Provider documents and resources

These documents and resources apply to all counties in Kentucky.

Humana Healthy Horizons in Kentucky Provider Resource Guide, PDF

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

2021 Humana Healthy Horizons in Kentucky Enrollee Handbook, PDF

2022 Humana Healthy Horizons in Kentucky Enrollee Handbook, PDF

Access our online Find a Doctor service

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

Behavioral health after-hours availability information, PDF

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

Preauthorization for Advanced Imaging Services, PDF

Medicaid Prior Authorization and Notification List, PDF

Provider Resource Guide – Transition Details, PDF

Referral to Medicaid Case Management Form, PDF

Value-Added Services Provider Guide , PDF

Moms First Provider Reference Guide, PDF

Pacify Smartphone App Provider Information, PDF

Moms First StrongWell Services Provider Information, PDF

Pharmacy resources

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

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

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

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

  • Call MedImpact at 844-336-2676
  • Fax 858-357-2612
  • Use the Cover My Meds, Surescripts, or CenterX ePA online 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 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

Abortion Consent Form, PDF

Claim Dispute Form, PDF

Notification of Pregnancy Form, PDF

Early elective deliveries (EEDs)

EEDs prior to 39 weeks gestation_06232017, PDF

Addendum to EEDs prior to 39 weeks gestation_06232017, PDF

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

Incarceration status correction, PDF

The sample coordination of care letter below can be used when providing behavioral health updates to primary care providers.

Sample coordination of care letter, PDF

Hospice Consent Form, PDF

Provider Grievance Form, PDF

Hysterectomy Consent Form, PDF

Sterilization Consent Form, PDF

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
  • 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

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 a phone call through the app, Monday through Friday, from 7 a.m. to 7 p.m., Eastern time, 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 needs
  • 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.

Centers for Disease Control and Prevention HEAR HER campaign

The Centers for Disease Control and Prevention (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

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 and board-certified and 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 primary care physician and/or a specialist, and when a visit to a retail clinic, urgent care center, or emergency room (ER) 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, 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® 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 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