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 health care coverage for income-eligible children, seniors, disabled adults and pregnant women. It is funded by both the state and federal governments.
Urgent MMA updates
The following documents are provided to help physicians and clinicians locate the latest information for Humana Medical Plan:
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, 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
Statewide Medicaid Managed Care: Continuity of Care Provisions
The Agency for Health Care Administration (Agency) contracts with Medicaid health and dental plans to provide services to health plan enrollees in the Statewide Medicaid Managed Care (SMMC) program. The Agency recently entered into new contracts with health and dental plans. As part of those contracts, the Agency achieved program changes that greatly benefit enrollees and providers.
The Agency will transition to the new contracts through a regional phased roll-out.The first regional roll-out occurred on Saturday, December 1, 2018. Roll-out for phase two will occur Tuesday, January 1, 2019.
Health and dental plans are required to ensure continuity of care (COC) during the transition period for Medicaid recipients enrolled in the SMMC program. COC requirements ensure that when 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), their services continue seamlessly throughout their transition.
The Agency 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 roll-out date in each region.
- Humana Florida Medicaid Vaccines for Children (VFC) Program and Child Blood Lead Screening – As part of Humana’s focus on preventive health, we want all infants and children to receive recommended immunizations and screenings.
Additionally, as detailed under section 1905(r)(1)(B)(iii) of the Social Security Act, Humana is required to remind physicians regarding their participation in the Vaccines for Children (VFC) program. More information regarding ordering VFC program vaccines is available on the , opens new window
It is important to maintain adequate vaccine supplies. Find , opens new window
Federal regulations also require that children receive a blood screening for lead at 12 months old and at 24 months old.
If you have questions regarding the VFC program or blood lead screenings, please contact the Humana Quality Management department at 1-305-626-5252.
Oncology Analytics (OA) reviews preauthorization requests for Humana-covered patients’ chemotherapy agents, supportive drugs and symptom management drugs. OA provides this service for all Humana lines of business, with the exception of TRICARE.
Please submit all requests for chemotherapy agents, supportive drugs and symptom management drugs for your patients with Humana Medical Plan (Medicaid) coverage to Oncology Analytics.
Choose from the following options to submit a preauthorization request:
- , opens new window (participating cancer-care physicians only).
- Fax a completed , opens new window to 1-954-622-2431. Please use a secure cover sheet when sending a fax.
Please note: Physicians must call 1-888-916-2616 to obtain a username and password.
For more information, please refer to , opens new window or contact your OA provider relations representative at 1-888-916-2616.
How to request preauthorization
Except where noted preauthorization requests for medical services may be initiated:
- Online via Availity.com (registration required)
- By calling Humana’s interactive voice response (IVR) line at 1-800-523-0023 (available Monday through Friday, 8 a.m. to 6 p.m. Eastern time)
Please 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 may be initiated:
- By sending a fax to 1-888-447-3430 (request forms are available at Humana.com/medpa)
- By calling 1-866-461-7273 (available Monday through Friday, 6 a.m. to 8 p.m. Eastern time)
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)
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 patients with Medicaid coverage. , opens new window provides information regarding telemedicine services reimbursement and Florida Medicaid’s requirements.
Effective Oct. 1, 2017, physicians and other healthcare professionals who administer vaccines to Florida Medicaid recipients birth through age 20 will be required to submit both the vaccine product Current Procedural Terminology (CPT) code as well as the vaccine administration CPT code on the claim in order. , PDF opens in new window to receive reimbursement from Florida Medicaid through the fee-for-service delivery system.
If more than one vaccine is administered during the same visit, each vaccine code and an administration code for each vaccine must be submitted on the claim form.
New urgent care centers join Humana
The following urgent care centers have joined Humana’s Medicaid network:
- Nine locations in Broward County
- 11 locations in Miami-Dade County
- 10 locations in Palm Beach County
Community Health of South Florida
- Two locations – Cutler Bay and Homestead
Physicians are requested to encourage their Humana-covered patients to contact their offices after-hours and to visit the nearest urgent care center when unable to be seen at their physician’s office.
To find Humana-participating urgent care centers near your practice, visit Humana.com and choose the “Find a doctor” link.
Humana-covered patients can find the nearest Humana-participating urgent care centers online at Humana.com using the “Find a doctor” link, or by calling Humana Customer Service at 1-800-477-6931 (TTY: 711), Monday through Friday from 8 a.m. to 8 p.m. Eastern time.
Humana supports physicians and clinicians to ensure safe opioid utilization Humana is working with physicians and clinicians to address safety concerns about opioid utilization by Humana-covered patients.
Electric 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. Humana will also cover breast pumps when they meet medical necessity criteria.
This publication provides updates for Humana Medicaid HMO network physicians and healthcare providers in Florida.
- New Florida regions go live starting Dec. 1
- Updated provider manual
- Preauthorization list updates
- Regional Perinatal Intensive Care Centers
- New email address for encounter-related inquiries
- Mandatory Medicaid enrollment
- 2018 Provider Compliance Training
Find past editions of this publication for Humana Family Medicaid HMO network physicians and healthcare providers in Florida.
The following documents provide important resources for physicians and other healthcare providers specific to Florida Medicaid members:
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 MMA coverage keep 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.
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 Availity Web 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:
MMA Newly Covered Services
Additional training materials for healthcare providers
This guide includes important information regarding hospice billing.
This orientation presentation covers topics specific to obstetricians and gynecologists who serve Humana MMA plans.
, 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 , PDF opens in new window