Humana Managed Medical Assistance (MMA) program

Humana has contracted with the Agency for Health Care Administration (AHCA) to provide services to Medicaid beneficiaries through Humana Managed Medical Assistance (MMA) plans. Medicaid provides healthcare coverage for income-eligible children, seniors, disabled adults and pregnant women. It is funded by both the state and federal governments.

Provider resources

Florida regions MMA provider education materials MMA provider pharmacy materials MMA provider quality resources MMA provider training materials

Region 1: Escambia, Okaloosa, Santa Rosa and Walton counties

Region 2: Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla and Washington counties.

Region 3: Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee and Union counties

Region 4: Baker, Clay, Duval, Flagler, Nassau, St. Johns and Volusia counties

Region 5: Pasco and Pinellas counties

Region 6: Hardee, Highlands, Hillsborough, Manatee and Polk counties

Region 7: Brevard, Orange, Osceola and Seminole counties

Region 8: Charlotte, Collier, DeSoto, Glades, Hendry, Lee and Sarasota counties

Region 9: Indian River, Martin, Okeechobee, Palm Beach and St. Lucie counties

Region 10: Broward County

Region 11: Miami-Dade and Monroe counties

 Map of Florida Regions

MMA provider education materials

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

Provider Resource Guide , PDF opens in new window

Florida Medicaid Existing Expanded Benefits , PDF opens in new window

Expanded Benefit – Hepatitis A Vaccine for Adults Coverage Information , PDF opens in new window

Humana Medical Plan Florida Medicaid Member Handbook , PDF opens in new window

Breast pump coverage , PDF opens in new window

Breast pumps have been added to AHCA’s Medicaid Durable Medical Equipment (DME) schedule as a covered benefit when they meet the medical necessity criteria.

Statewide Medicaid Managed Care (SMMC): continuity of care (COC) Provisions

Health and dental plans are required to ensure continuity of care during the transition period for Medicaid recipients enrolled in the SMMC program. COC requirements ensure that, as enrollees transition from one health plan to another, one service provider to another, or one service delivery system to another (i.e., fee-for-service to managed care), they experience no lapse in service.

AHCA has instituted the following COC provisions:

  • Healthcare providers should not cancel appointments with current patients.
  • Health plans must honor any ongoing treatment that was authorized prior to the recipient’s enrollment into the plan for up to 60 days after the rollout date in each region.

Continuity of Care Provisions Program Highlight , link opens in new window

Continuity of Care Information – SMMC Plan Website Links , link opens in new window

MPIP Education Materials

MMA Physician Incentive Program (MPIP)

Medicaid Preauthorization and Notification List (PALs) , link opens in new window

How to request other preauthorization

Except where noted, preauthorization requests for medical services may be initiated:

  • Online via Availity.com, link opens in new window (registration required)
  • By calling Humana’s interactive voice response (IVR) line 24-hours a day at 1-800-523-0023 (Humana customer care representatives are available Monday through Friday, 8 a.m. to 8 p.m. Eastern time)

NOTE: Online preauthorization requests are encouraged. Additionally, clinical information for a medical service preauthorization request may be faxed to 1-813-321-7220.

Except where noted, preauthorization requests for medications billed as medical claims may be initiated:

Except where noted, preauthorization requests for durable medical equipment (DME) may be initiated:

  • For regions 1-8: by calling 1-866-856-8974, the Humana clinical intake team, (available Monday through Friday, 8 a.m. to 5 p.m. Eastern time)
  • For regions 9-11: by sending a fax to 1-855-441-6941 (One Homecare Solutions) or calling 1-855-441-6900 (available Monday through Friday, 8:30 a.m. to 9 p.m., Saturday and Sunday, 9 a.m. to 5 p.m. Eastern time)

Case management education materials

Referral to Medicaid Case Management Form (All Regions) , PDF opens in new window

Urgent MMA updates

The following documents are provided to help physicians and clinicians locate the latest information for Humana Medical Plan:

MMA Provider Participation Rejection Notice, PDF opens in new window

Florida Medicaid Urgent Updates (from past 90 days), PDF opens in new window

Florida Medicaid Urgent Updates Archive (older than 90 days), PDF opens in new window

Third Quarter 2019 Updates for Physicians and Healthcare Providers, PDF opens in new window

This publication provides updates for Humana Medicaid HMO network physicians and healthcare providers in Florida.

Topics include:

  • Access to Care Requirements for Humana Medicaid members
  • Patient-Centered Medical Home (PCMH) workshops
  • 2019 Medicaid Quality Bonus Program
  • Maintaining Current Provider Addresses
  • Revised Florida Medicaid Provider Manual
  • Humana’s 2019 provider compliance training
  • MMA Physician Incentive Program (MPIP Year 3*)
  • Online self-service
  • Pharmacy Information

Humana Updates for Physicians and Healthcare Providers Archive, PDF opens in new window

Find past editions of this publication for Humana Family Medicaid HMO network physicians and healthcare providers in Florida.

MMA Provider reference materials

Florida Medicaid coverage for telemedicine

Humana is looking for physicians who currently provide telemedicine services, or would like to learn more about this convenient alternative for Medicaid patients. The “What Physicians Need to Know about Telemedicine” flyer, PDF opens in new window provides information regarding telemedicine services reimbursement and Florida Medicaid’s requirements.

Electronic health records

Behavioral Health Toolkit for Primary Care Physicians (PCPs) , PDF opens in new window - Region 1 and 2 only Home health visit information

MMA provider quality resources

The following documents provide important resources for physicians and other healthcare providers specific to Florida Medicaid members:

Child Health Checkup , PDF opens in new window

Prenatal and postpartum care for women , PDF opens in new window

Health options to help moms and babies fight the opioid epidemic (Regions 3-11) , PDF opens in new window

Sample patient services letters

There are many reasons patients miss the medical services and tests that are valuable to their health. Humana has developed tools physicians can use to help patients with keep their MMA coverage current. The adult sample services letter provides a checklist of the recommended health services and tests for adult MMA members, including preventive screenings, medications and diabetes care. The pediatric sample services letter provides a checklist of the recommended health services and tests for pediatric MMA members, including preventive screenings and medications.

Physicians can:

  • Download and customize the letter(s) for their letterheads, their communication styles and patients’ needs.
  • Distribute the letter(s) to their MMA-covered adult and/or pediatric patients, regardless of the patients’ health benefits plan membership.

Sample Adult Services Template Letter , PDF opens in new window

Sample Pediatric Services Template Letter , PDF opens in new window

MMA Provider Training Materials

Annual 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 provider portal (registration required) or manually using the “Training Requirements for Healthcare Providers Who Are Unable to Register” link below. Please refer to the following for more information:

Compliance Requirements for Healthcare Providers – Frequently Asked Questions and Answers , PDF opens in new window

How to Complete the Training Requirements via Availity.com , PDF opens in new window

Training Requirements for Healthcare Providers Who Are Unable to Register , PDF opens in new window

MMA Newly Covered Services

Early Intervention Services and Child Health Services Targeted Case Management , PDF opens in new window

Early Intervention Services and Child Health Services Snapshot , PDF opens in new window

Reporting Florida children’s Medicaid EIS, TCM and therapy services

Released July 2019: Learn about Humana’s approach to early intervention services (EIS), targeted case management (TCM) and therapy services, and the guidelines for claims submission and other related processes. This presentation applies to claims submitted for services rendered to children with Humana Florida Medicaid plans. This presentation includes a printable tip sheet. Runtime: 8:33 minutes
https://www.brainshark.com/humana/FLMedicaidEISandTCM , link opens in new window

Medical Foster Care – Provider Training and billing guide , PDF opens in new window

Medical Foster Care Snapshot , PDF opens in new window

MMA Nursing Facility – Provider Training and billing guide , PDF opens in new window

MMA Nursing Facility Snapshot , PDF opens in new window

MMA Nursing Facility Admission Notification Report Template , PDF opens in new window

Additional training materials for healthcare providers

Cultural Competency Plan for Florida , PDF opens in new window

Florida Medicaid preauthorization list training for regions 9, 10 and 11 , PDF opens in new window

Florida SMMC reference guide for hospice Medicaid services , PDF opens in new window

This guide includes important information regarding hospice billing.

MediKids vaccines billing and service guideline , PDF opens in new window

This document contains Humana’s guidance related to MediKids vaccines and associated billing and reimbursement information.

Long-Acting Reversible Contraception (LARC) Coverage with Inpatient Services Billing Guide , PDF opens in new window

Long Acting Reversible Contraceptives (LARCs) , PDF opens in new window

Medicaid-participating obstetricians and gynecologists training , PDF opens in new window

This orientation presentation covers topics specific to obstetricians and gynecologists who serve Humana MMA plans.

Provider-initiated Member Transfer Process , PDF opens in new window

This document explains the process that a physician or other healthcare provider needs to follow to submit a transfer request of a Florida Medicaid MMA, Title XXI MediKids or long-term-care (LTC) member from his/her office to another provider’s office. Download the Provider-initiated Member Transfer Request Form, PDF opens in new window.