Provider materials

Humana Integrated Care Program of Illinois and Humana Gold Plus Integrated (Medicare-Medicaid)

Illinois joint CMS-State sponsored Medicare Medicaid Alignment Initiative ("Demonstration") and Illinois Integrated Care Program (ICP) Appendix

The document below highlights the key points related to Humana Demonstration and ICP policies and procedures and is an extension of participating health care providers' contracts. It is intended to be a guideline to facilitate and inform health care providers on what the Illinois Demonstration and ICP is about, what Humana needs from health care providers and what health care providers can expect from Humana.

Illinois joint CMS-State sponsored Medicare Medicaid Alignment Initiative ("Demonstration") and Illinois Integrated Care Program (ICP) Appendix - English – effective Sept. 1, 2016, PDF opens new window

Illinois joint CMS-State sponsored Medicare Medicaid Alignment Initiative ("Demonstration") and Illinois Integrated Care Program (ICP) Appendix - English – effective March 2014, PDF opens new window

Illinois joint CMS-State sponsored Medicare-Medicaid Alignment Initiative (MMAI) and Illinois Integrated Care Program (ICP) Appendix Bulletins

Medical Transportation Management provides non-urgent medical transportation for patients with Humana Integrated Care Program (ICP) of Illinois (Medicaid) and Humana Gold Plus Integrated (MMAI) coverage – Effective July 1, 2017, PDF opens new window

Humana supports physicians and clinicians to ensure safe opioid utilization – Effective July 1, 2017, PDF opens new window

Humana Gold Plus Integrated (Medicare-Medicaid) preauthorization and notification list

The document below lists services and medications for which preauthorization may be required for Humana Gold Plus Integrated (Medicare-Medicaid) members. Please review the detailed information at the top of the lists for exclusions and other important information before submitting a preauthorization request.

Jan. 22, 2018, Medicare and Dual Medicare-Medicaid Plans Preauthorization and Notification List – English, PDF opens new window

Jan. 23, 2017, Medicare and Dual Medicare-Medicaid Plans Preauthorization and Notification List – English, PDF opens new window

You can also download previous versions of the preauthorization and notification, opens new window list.

Humana Gold Plus Integrated (Medicare-Medicaid) Prescription Drug Guide

2016 Prescription Drug Guide – English, PDF opens new window

2016 Prescription Drug Guide – Spanish, PDF opens new window

2017 Prescription Drug Guide – English, PDF opens new window

2017 Prescription Drug Guide – Spanish, PDF opens new window

Cultural Competency Program Information

Cultural Competency Program for Illinois, PDF opens new window

Compliance requirements for health care providers

Humana and the state of Illinois require that all entities that participate with dual Medicare-Medicaid plans and Medicaid plans, including those contracted with subsidiaries, complete the following training materials:

  • Cultural Competency Training
  • Health, Safety and Welfare Education Training
  • Medicaid Provider Training
  • Humana Orientation Training
  • Compliance and Fraud, Waste and Abuse Training

The information below is provided to help you meet these requirements

Frequently asked questions and answers

This document provides additional information regarding the compliance requirements and Web access.

Compliance Requirements for Health Care Providers – Frequently Asked Questions and Answers, PDF opens new window

Availity.com instructions

This document covers how to complete the compliance requirements on Availity.com, how to register on Availity.com, how to create a new user, how to assign the compliance business function to another user and how to update an organization's TIN.

How to Complete the Training Requirements via Availity.com, PDF opens new window

If your organization is unable to register on Humana.com or Availity.com, opens new window, refer to the following document:

Training Requirements for Health Care Providers Who Are Unable to Register, PDF opens new window

Medicaid Hospice Benefit Election

The Illinois Department of Healthcare and Family Services (HFS) requires the submission of the Medicaid hospice benefit election standardized form to HFS for patients with Medicaid and dual Medicare-Medicaid coverage who elect hospice care. Hospice providers must complete the form for each hospice patient. (Please see this notice):, opens new window

Hospice Benefit Election Form, opens new window

This form must also be submitted to HFS when a patient dies, ceases hospice care or transfers to another hospice. Effective May 1, 2014, use of this form is mandatory. Hospices are asked to allow two weeks after submittal of the HFS 1592 before submitting a claim.

Please visit Illinois government’s forms and documents page, opens new window for Illinois Medicaid forms.

If a patient is covered under a managed care entity (MCE) contracted with HFS, hospice providers must also submit a copy of the HFS 1592 form to the MCE.

For patients with Humana Integrated Care Program of Illinois (Medicaid) or Humana Gold Plus Integrated (Medicare-Medicaid) coverage via Humana, submit a copy of the HFS 1592 form to Humana using one of the following methods: Email: DualDemoEnrollmentEscalations@humana.com

Mail: P.O. Box 14168
Lexington, KY 40512-4168

Questions regarding this notice should be directed to the hospice’s billing consultant in the Bureau of Comprehensive Health Services at 1-877-782-5565.

Long-term services and supports (LTSS) provider portal

Long-term services and supports (LTSS) providers who need information regarding eligibility, authorizations and claims status can access the LTSS provider portal., opens new window