Medicaid Long-Term Care Managed Care Program

Thanks to the healthcare providers who participate with the Humana long-term care plan provider network and provide quality, accessible services to their Humana-covered patients throughout Florida.

This page is designed to give healthcare providers quick access to current information 24 hours-a-day, seven days-a-week. In addition, providers will find useful information about other Humana long-term care programs and resources.

Healthcare providers who want to work with Humana LTC online can register for the Availity web portal at no cost. This multi-payer portal allows providers to interact securely with Humana and other participating payers without learning to use multiple systems or remembering different user IDs or passwords for each payer. Many Humana-specific tools are accessible from the Availity portal. To learn more, call Availity at 1-800-282-4548 or visit the Availity website., opens new window

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 [], opens new window and select “Login.”

Electronic Visit Verification

Beginning Dec. 1, 2019 Humana requires home healthcare providers to use HHAeXchange to submit confirmed visits and bill claims through the HHAeXchange portal. The first step in effectively working with Humana is to fill out the HHAeXchange questionnaire for each organization. The questionnaire, PDF opens new window 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 1-855-400-4429 or visit the HHAeXchange, opens new window website.

HHAeXchange healthcare provider functions include:

  • FREE Electronic Visit Verification (EVV) tools
  • Open Model EDI Integration with 3rd 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 1-888-998-7735
Member call center number is 1-888-998-7732

Effective for claims with dates of service on or after Dec. 4, 2020, Humana will deny provider claims submitted to the plan outside of HHAeXchange by those who submit less than 25% of their personal care services or home health services claims through HHAeXchange. The measurement of less than 25% EVV compliance will be based on a quarterly historical look-back period.

In accordance with AHCA guidelines, if it is determined that a provider has submitted less than 25% of claims to Humana via HHAeXchange, any submitted EVV claims that were not billed via HHAeXchange will be subject to this claims denial until further notice. Claims that are denied can be resubmitted via HHAeXchange to be processed as a corrected claim.

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

Additional information

2020 Comprehensive Long-Term Care Provider Resource Guide, PDF opens new window

Hospice, ALF and SNF Authorizations No Longer Required – Effective August 5, 2020, PDF opens new window

Contact information for our regional provider contracting representatives, PDF opens new window

Medicaid Long-Term Managed Care Program, PDF opens new window

Florida Medicaid Provider Manual (effective 11/1/2019), PDF opens new window

Provider Directory, PDF opens new window

Provider Training Calendar, PDF opens new window

Provider eBilling Companion Guides, PDF opens new window

Electronic Billing via Availity, PDF opens new window

Cultural Competency Plan, PDF opens new window 

Health care provider training materials

Annual compliance training materials for health care providers

The Centers for Medicare & Medicaid Services (CMS) and state Medicaid contracts mandate that all Humana-contracted physicians and other health care providers complete compliance program requirements. Health care 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 opens new window

How to Complete the Training Requirements via the Provider Portal, PDF opens new window

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

Additional training materials for healthcare providers

Florida SMMC Reference Guide for Hospice Medicaid Services, PDF opens new window

This guide includes important information regarding hospice billing.