Provider documents

Humana Healthy Horizons in Florida Provider Manual - Effective April 1, 2021, PDF opens new window

Humana Healthy Horizons in Florida Provider Resource Guide, PDF opens new window

Humana Healthy Horizons in Florida Expanded Benefits, PDF opens new window

Electronic Visit Verification (EVV) Claims Submission Requirements (Effective June 21, 2021) , PDF opens new window

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

Humana Hospital Discharge Planning Guide, PDF opens new window

Humana Healthy Horizons in Florida Member Handbook, PDF opens new window

Breast Pump Coverage Information, PDF opens new window

Access to Care Requirements for Humana Healthy Horizons in Florida Members, PDF opens new window

For Pediatric Therapy access-to-care issues or complaints, please contact:

Theresa Bell
Humana - Senior Process Improvement Professional
Phone: (502) 354-1364
Email: FLMedicaidResolution@humana.com

OB-GYN provider documents

Humana Healthy Horizons in Florida Moms First Provider Orientation Training, PDF opens new window

Humana Healthy Horizons in Florida Family-Planning Services Provider Overview, PDF opens new window

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

Notification of Pregnancy Form, PDF opens new window

My Birth Matters
The Florida Department of Health (Department), the Agency for Health Care Administration (Agency), the Florida Perinatal Quality Collaborative (FPQC), and the Florida Hospital Association (FHA) have partnered to promote vaginal deliveries and reduce unnecessary C-section deliveries for expectant mothers with low-risk pregnancies. Below, you’ll find information that can help you have a healthy pregnancy and baby.

Access My Birth Matters tools and resources, opens new window

Florida Perinatal Quality Collaborative (FPQC)

The FPQC, opens new window was established in 2010 to improve Florida’s maternal and infant health outcomes through the delivery of high-quality, evidence-based perinatal care. As a participating provider, Humana Healthy Horizons in Florida encourages our network of health professionals and hospitals to participate in the various statewide initiatives to improve maternal and infant outcomes.

Initiatives include:

Maternal Opioid Recovery Effort (MORE)
According to the Florida Perinatal Quality Collaborative, overdoses are the leading cause of pregnancy-associated death in Florida. The purpose of MORE is to improve identification of, and clinical care and coordinated treatment/support for, pregnant women with opioid use disorder and their infants.

Important resources for OB providers, PDF opens new window

Information about Narcan/Naloxone, PDF opens new window

Talking to your patients about risks of drinking and drug use during pregnancy, PDF opens new window

Talking to your patients about addiction(s), PDF opens new window

Learn more about the MORE initiative, opens new window

Promoting Primary Vaginal Deliveries (PROVIDE)

The PROVIDE Initiative aims to improve maternal and newborn outcomes by applying evidence-based interventions to promote primary vaginal deliveries and reduce NTSV cesareans.

Learn more about the PROVIDE Initiative, opens new window

Neonatal Abstinence Syndrome (NAS) Initiative

The NAS Initiative develops and promotes standardized approaches to address variability in NAS management and decrease neonatal length of hospital stay due to NAS.

Learn more about the Neonatal Abstinence Syndrome Initiative, opens 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 SMMC-enrolled Medicaid recipients. COC requirements ensure that members transfer without service lapse between health plans, service providers and service delivery systems (i.e., fee-for-service to managed care).

AHCA has instituted the following COC provisions:

  • Healthcare providers should not cancel appointments with current patient
  • For 60 days after the rollout date in each region, health plans must honor any ongoing treatment authorized prior to the recipient’s enrollment into that plan

Continuity of Care Provisions Program Highlights, PDF opens new window

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

MMA Physician Incentive Program (MPIP) Education Materials

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

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

Case management education materials and forms

Available Humana Healthy Horizons in Florida Clinical Programs, PDF opens new window

Controlling and Managing Sickle Cell Disease, PDF opens new window

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

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

Humana Healthy Horizons in Florida Case Management Recommendations for Heart Failure, PDF opens new window

Humana Healthy Horizons in Florida Case Management Recommendations for Diabetes, PDF opens new window

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

MMA updates and notices

The following documents are provided to help physicians and clinicians locate the latest information for Humana Healthy Horizons in Florida:

Introducing Humana Healthy Horizons in Florida - Effective Apr. 1, 2021, PDF opens new window

Health Network One (HN1) Termination – Region 9, PDF opens new window

Updated Transportation Services Information for Humana Healthy Horizons in Florida Members, PDF opens new window

Go365 for Humana Healthy Horizons Provider Flyer, PDF opens new window

Durable Medical Equipment Provider Informational Resource, PDF opens new window

Real-time Reporting for Private Duty Nursing Services & Claims Submission Process Revisions, PDF opens new window

Interim Billing for Inpatient Hospital Services, PDF opens new window

Electronic Visit Verification (EVV) Thresholds and Compliance Timelines, PDF opens new window See guidance effective as of June 21, 2021 above or at Electronic Visit Verification in Managed Care, PDF opens new window

Claim Dispute Notification, PDF opens new window

MMA Provider Participation Rejection Notice, PDF opens new window

Humana Healthy Horizons in Florida Provider Newsletter

Florida New Horizon Provider Newsletter, PDF opens new window

Provider Newsletter Archive, PDF opens new window

How to request other prior authorization

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

Except where noted, prior authorization 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 800-523-0023 (Humana customer care representatives are available Monday - Friday, 8 a.m. - 8 p.m. Eastern time)

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

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


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

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

Virtual (Telemedicine) Visits

MMA updates and notices

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

Improving Continuity of Care with Telemedicine, PDF opens in new window

Our members now also have access to 24/7 virtual visits through MDLIVE®. See our New 24/7 Telemedicine Services flyer, PDF opens in new window to learn more about MDLIVE®.

Virtual care (telemedicine) services with MDLIVE

Our members can connect with board-certified, state-licensed doctors 24 hours a day, seven days a week via virtual visits with MDLIVE®.

As virtual-patient-visit experts, MDLIVE® doctors can provide treatment for a variety of healthcare needs, including cold and flu symptoms, skin conditions, medication adjustments and prescription refills of many common drugs.

While members have access to this service, we also educate them about why and when to seek care from their primary care provider and/or a specialist, retail clinic, urgent care center or emergency room.

To receive care via MDLIVE®, our members can:

  1. Go to MDLIVE.com/HumanaMedicaid, opens in new window*, create an account and connect with a doctor
  2. Call 844-403-0556 (TTY: 711), 24 hours a day, seven days a week
  3. Download the MDLIVE mobile app from the App Store® or Google Play®

*Internet access required

For more information about MDLIVE®, please visit Humana.com/FloridaVirtualCare, opens in new window