Medicaid Long-Term Care Managed Care Program

We want to thank the providers participating in the Humana Healthy Horizons® Long-Term Care provider network for providing quality, accessible services to their Humana-covered patients in Florida.

Below, you’ll find key information, including the provider resource guide, working with us online, notices from the Agency for Health Care Administration (AHCA).

Become a participating provider in the Florida Medicaid program

Providers must complete an enrollment application with the Agency for Health Care Administration (AHCA) to be eligible to provide services to Medicaid recipients in Florida. You can complete the application online using AHCA’s online enrollment wizard.

Join the Humana Healthy Horizons in Florida Long-Term Care Provider Network

Providers interested in joining our long-term care provider network can complete an application online. You have to provide information about you/your practices, your license, and how we can reach you.

Request to join our long-term care network

Healthcare providers who want to work with Humana LTC online can register through the Availity portal at no cost. This multi-payer portal allows providers to interact securely with Humana and other participating payers all in one place. Many Humana-specific tools are accessible through the Availity portal. To learn more, call Availity at 800-282-4548 or visit the Availity website

Availity provides functions such as the following:

  • Humana member ID card look-up
  • Claims status and remittance information
  • Electronic claims submission
  • Authorization inquiry

Healthcare providers already registered with Availity can sign in to the secure Availity provider website [] and select “Login.”

Electronic Visit Verification

Beginning Dec. 1, 2019 Humana requires home healthcare providers to use the HHAeXchange portal to submit confirmed visits and bill claims. The first step in effectively working with Humana is to fill out the following questionnaire for each organization. The questionnaire, PDF answers allow HHAeXchange to configure the agency’s portal. Please note that providers only need to fill out the questionnaire once, regardless of MCO contracts the provider holds. To learn more, call HHAeXchange at 855-400-4429 or visit the HHAeXchange website.

HHAeXchange healthcare provider functions include:

  • FREE electronic visit verification (EVV) tools
  • Open model EDI Integration with third party EVV Vendors
  • Real-time, two-way messaging with each MCO
  • Electronically receive recipient demographics, authorizations and plans of care
  • Pre-bill scrubbing to ensure clean claims and accelerate revenue cycle

Provider call center number is 888-998-7735
Member call center number is 888-998-7732

Effective for dates of service beginning June 21, 2021, Humana Healthy Horizons in Florida will deny all claims for personal care services and home health services submitted outside HHAeXchange.

Claims for personal care services and home health services may only be processed outside of HHAeXchange on a case-by-case basis where there is a documented vendor system issue that prevents the healthcare provider from billing through HHAeXchange. When there are technical issues between healthcare providers and HHAeXchange, providers should:

Upon receipt, Humana Healthy Horizons™ in Florida will review each technical issue case and determine if the claim is exempt from the denial.

For questions regarding Humana Healthy Horizons in Florida’s EVV, please call HHAeXchange at 855-400-4429.

Electronic Visit Verification (EVV) Thresholds and Compliance Timelines, PDF

Additional information

Assisted living facility provider billing guidance, PDF

Comprehensive Long-Term Care Provider Resource Guide, PDF

Important reminder regarding assisted living and skilled living facility (ALF/SNF) authorizations, PDF

Faxed authorizations for assisted living facilities, skilled nursing facilities, and hospice services, PDF

Contact information for our regional provider contracting representatives, PDF

Cultural Competency Plan, PDF

Electronic Billing via Availity

Humana Healthy Horizons in Florida Provider Manual – Effective March 3, 2022 , PDF

Humana Healthy Horizons in Florida Provider Manual - Effective April 1, 2021, PDF

Medicaid Long-Term Managed Care Program, PDF

Provider Directory, PDF

Provider eBilling Companion Guides, PDF

Provider Training Calendar, PDF

Compliance training materials for healthcare providers

The Centers for Medicare & Medicaid Services (CMS) and state Medicaid contracts mandate that all Humana-contracted physicians and other healthcare providers complete compliance program requirements. Healthcare providers can complete this requirement online at the Availity Web Portal (registration required) or manually using the “Training Requirements for Health Care Providers Who Are Unable to Register” link below. Please refer to the following for more information:

Compliance Requirements for Health Care Providers – Frequently Asked Questions and Answers, PDF

How to Complete the Training Requirements via the Provider Portal, PDF

Training Requirements for Health Care Providers Who Are Unable to Register, PDF

Additional training materials for healthcare providers

Florida SMMC Reference Guide for Hospice Medicaid Services, PDF

This guide includes important information regarding hospice billing.