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:

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

Provider resources

Florida regions Provider Documents Provider communications Provider quality resources 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, 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

View Florida regions map , PDF opens in new window

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 Florida SHOTSTM website., opens new window

It is important to maintain adequate vaccine supplies. Find more information about the VFC inventory here. , 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:

For more information, please refer to this Humana Quarterly Update , 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. The “What Physicians Need to Know about Telemedicine” flyer , opens new window provides information regarding telemedicine services reimbursement and Florida Medicaid’s requirements.

Vaccine billing

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. Please reference this Vaccine code billing flyer , 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:

MD Now

  • 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.

Provider Manual Appendix Bulletin , PDF opens in new window

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.

Breast pump coverage , PDF opens in new window

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.

Third Quarter 2018 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:

  • 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

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.

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

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

Child Health Checkup , PDF opens in new window

Oral health for children and adolescents , PDF opens in new window

Prenatal and postpartum care for women , 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 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.

Sample Adult Services Template Letter , PDF opens in new window

Sample Pediatric Services Template Letter , PDF opens in new window

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:

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

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 , 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.

Long-Acting Reversible Contraception (LARC) Coverage with Inpatient Services Billing Guide , 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 Provider-initiated Member Transfer Request Form , PDF opens in new window