Provider documents

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

Refer to the Humana Healthy Horizons in Florida Provider Resource Guide for information about resources we make available to providers.

Humana Healthy Horizons in Florida Provider Resource Guide, PDF

Refer to the Humana Healthy Horizons in Florida Resource Guide for a list of departments and personnel that can assist with the coordination and authorization of services that a patient in your panel with Humana Healthy Horizons coverage may need.

Humana Healthy Horizons in Florida Resource Guide, PDF

Humana Healthy Horizons in Florida Expanded Benefits, PDF

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

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

Humana Healthy Horizons in Florida Member Handbook, PDF

Breast Pump Coverage Information, PDF

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

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

When one of your patients moves out of your service area
Please notify Humana Healthy Horizons if you become aware that one of your patients with Humana Healthy Horizons in Florida coverage moves out of your service area. Please complete this notification form, PDF and send back by fax or email.

OB-GYN provider documents

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

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

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

Notification of Pregnancy Form, PDF

Florida Perinatal Quality Collaborative (FPQC)

The FPQC 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

Information about Narcan/Naloxone, PDF

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

Talking to your patients about addiction(s), PDF

Learn more about the MORE initiative

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

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

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

Continuity of Care Information – SMMC Plan Website Links, PDF

MMA Physician Incentive Program (MPIP) Education Materials

Humana MPIP Year 6 Plan Program Summary, PDF

Humana MPIP Year 5 Plan Program Summary, PDF

Humana MPIP Year 4 Plan Program Summary, PDF

Case management education materials and forms

Available Humana Healthy Horizons in Florida Clinical Programs, PDF

Controlling and Managing Sickle Cell Disease, PDF

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

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

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

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

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

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

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

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

Go365 for Humana Healthy Horizons Provider Flyer, PDF

Durable Medical Equipment Provider Informational Resource, PDF

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

Interim Billing for Inpatient Hospital Services, PDF

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

MMA Provider Participation Rejection Notice, PDF

Humana Healthy Horizons in Florida Provider Newsletter

Florida New Horizon Provider Newsletter, PDF

Provider Newsletter Archive, PDF

How to request other prior authorization

Medicaid Preauthorization and Notification List (PALs)

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

  • Online via Availity.com (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:

  • By sending a fax to 888-447-3430 (request forms are available at Humana.com/medpa
  • By calling 866-461-7273 (available Monday - Friday, 8 a.m. - 6 p.m. Eastern time)

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 provides information regarding telemedicine services, reimbursement and Florida Medicaid’s requirements.

Closing HEDIS Measure Care Gaps via Telemedicine, PDF

Using Virtual Visits for Annual Well Visits, PDF

Improving Continuity of Care with Telemedicine, PDF

Our members now also have access to 24/7 virtual visits through MDLIVE®. See our New 24/7 Telemedicine Services flyer, PDF 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*, 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