Urgent MMA updates

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

Interim Billing for Inpatient Hospital Services, PDF opens new window

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

Claim Dispute Notification, PDF opens new window

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

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

Provider Newsletter

Updates for Florida Physicians and Healthcare Providers, PDF opens new window

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

Topics include:

  • Coronavirus Disease 2019 (COVID-19) updates
  • What you need to know about Telemedicine
  • Provider enrollment requirements and resources
  • MMA Physician Incentive Program (MPIP Year 5)
  • Vaccination initiatives, billing and service guidelines
  • Pharmacy information
  • Flu season information and billing codes

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

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

Provider education materials

Florida Medicaid Provider Manual (effective 4/1/2021) , PDF opens in new window

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

Well-Child Immunization Initiative Flyer , PDF opens in new window

Flu Vaccinations: A Simple Way to Save Lives , PDF opens in new window

Provider Resource Guide , PDF opens in new window

Florida Medicaid Expanded Benefits , PDF opens in new window

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

Humana Hospital Discharge Planning Guide , 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.

Access to Care Requirements for Humana Medicaid Members , PDF opens in new window

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)

Humana MPIP Year 5 Plan Program Summary , PDF opens in new window

Humana MPIP Year 4 Plan Program Summary , PDF opens in new window

How to request other preauthorization

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

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

Florida Medicaid: Available Florida Medicaid Clinical Programs , PDF opens in new window

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

Humana Florida Medicaid Case Management Recommendations for Asthma , PDF opens in new window

Humana Florida Medicaid Case Management Recommendations for Chronic Obstructive Pulmonary Disease (COPD) , PDF opens in new window

Florida Medicaid Case Management Recommendations for Heart Failure , PDF opens in new window

Florida Medicaid Case Management Recommendations for Diabetes , PDF opens in new window

Humana Florida Medicaid Moms First Program Provider Reference Guide , PDF opens in new window

Medicaid Family Planning Services Provider Overview , PDF opens in new window

Controlling and Managing Sickle Cell Disease , PDF opens in new window

MMA Provider reference materials

Florida Medicaid Virtual (Telemedicine) Visits coverage

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.

Closing HEDIS Measure Care Gaps via Telemedicine, PDF opens in new window

Using Virtual Visits for Annual Well Visits, PDF opens in new window

Our members now also have access to 24/7 virtual visits through the Amwell website, opens in new window or mobile app. See our New 24/7 Telemedicine Services flyer, PDF opens in new window to learn more about Amwell virtual visits.

Electronic health records

Behavioral Health Toolkit for Primary Care Physicians (PCPs) , PDF opens in new window – Region 1 and 2 only

Available Services for Women with Opioid Use Disorder (OUD) , PDF opens in new window – Regions 1 and 2 only