Claims and payments

Have your Humana claims payments deposited automatically with electronic funds transfer (EFT) and electronic remittance advice (ERA). Visit Humana.com/EpaymentInfo for more information on EFT and ERA.

Gainwell Technologies handles the Louisiana Medicaid Pharmacy Benefits Management Program for Humana Healthy Horizons^® in Louisiana members. Our members must use Gainwell network pharmacies to get medications under the pharmacy benefit.

Find in-network pharmacies

Under “Provider Groups,” select Pharmacy.

Out-of-network claims

Humana Healthy Horizons in Louisiana established guidelines for payments to out-of-network providers for preauthorized medically necessary services. These services will be reimbursed at no less than 100% of the Louisiana Medicaid fee schedule. If the service is not available from an in-network provider, Humana Healthy Horizons may reimburse that provider less than the Medicaid fee-for-service rate.

Emergency and post-stabilization care services

We cover and pay for emergency and post-stabilization care services. Post-stabilization care can include:

• The determination of the emergency and/or post-stabilization care a Humana Healthy Horizons member needs
• The delivery of emergency and/or post-stabilization care to a Humana Healthy Horizons member

The Humana Healthy Horizons in Louisiana Provider Manual, PDF includes additional information about emergency and post-stabilization care services.

Reconsiderations and appeals

Get information about medical claim payment reconsiderations and member appeals for Humana participating and nonparticipating physicians, hospitals, and other healthcare providers.

Reconsiderations and appeals