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 (MMAI) and Illinois Integrated Care Program (ICP) Appendix Bulletins
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.
You can also download , opens new window list.
Humana Gold Plus Integrated (Medicare-Medicaid) Prescription Drug Guide
Cultural Competency Program Information
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.
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.
If your organization is unable to register on Humana.com or , opens new window, refer to the following document:
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. , 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 , 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 , opens new window