Humana contracted with the Kentucky Cabinet for Health and Family Services to provide services to Medicaid enrollees through Humana Health Plan. Medicaid provides healthcare coverage for income-eligible children, seniors, disabled adults, pregnant women and other eligible adults. It is funded by both the state and federal governments.

Provider Documents Provider communications & network notices Provider training materials

Humana Medical Coverage Policies are available on Humana.com. Humana uses nationally recognized medical necessity guidelines of Milliman Clinical Guidance (MCG) and American Society of Addiction Medicine (ASAM) criteria. Criteria are readily available for review by DMS, practitioners, the public or members upon request at no cost. MCG is available either verbally or in writing for DMS, practitioners, the public or members upon request. For providers and practitioners, the process to obtain criteria is communicated annually in the provider newsletter and in the provider manual.

These documents apply to all counties in Kentucky.

COVID-19 Information about how the Kentucky Department for Public Health uses contact tracing to help stop the spread of diseases , PDF opens new window

COVID-19 Additional Guidance Related to Authorizations and Referrals - May 21, 2020 , PDF opens new window

COVID-19 Temporary Out-of-Network Provider Enrollment Instructions and Claims-Processing Information , PDF opens new window

COVID-19 Kentucky’s Department for Medicaid Services (KDMS) Answers to Frequently Asked Questions , PDF opens new window

COVID-19 Guidance from KDMS – March 11, 2020 , PDF opens new window

COVID-19 Humana Answers to Frequently Asked Questions , PDF opens new window

KDMS Urine Drug Testing Policy (Effective July 1, 2020) , PDF opens new window

Provider Resource Guide- Transition Details, PDF opens new window

Kentucky Medicaid Provider Manual, PDF opens new window

Medicaid Preauthorization and Notification List, PDF opens new window

Humana Medical Plan Kentucky Medicaid Member Handbook, PDF opens new window

Abortion Consent Form, PDF opens new window

Hospice Consent Form, PDF opens new window

Sterilization Consent Form, PDF opens new window

Hysterectomy Consent, PDF opens new window

Kentucky Medicaid Pharmacy and Therapeutics Information, opens new window

Pharmacy quick reference guide, PDF opens new window

Preferred Drug List – English, PDF opens new window

Preferred Drug List – Spanish, PDF opens new window

Referral to Medicaid Case Management Form, PDF opens new window

Other Resources

Below are several helpful resources that may provide additional guidance and information.

Kentucky Health Information Exchange (KHIE), opens new window

Cabinet for Health and Family Services (CHFS), opens new window

Department for Medicaid Services (DMS), opens new window

Credentialing Verification , opens new window

Continuity of Care Provisions

A prior authorization (PA) shall be honored by the Humana Health Plan for 90 days or until the recipient or provider is contacted by the Humana Health Plan regarding the PA. If the recipient and provider are not contacted by Humana Health Plan, the existing Medicaid PA shall be honored until expired.

How to request preauthorization

Except where noted preauthorization requests for medical services may be initiated:


Except where noted, preauthorization requests for professionally administered medications may be initiated:

  • By sending a fax to 1-888-447-3430 (request forms are available at Humana.com/medpa
  • By calling 1-866-461-7273 (available Monday through Friday, 6 a.m. to 8 p.m. Eastern time)

Except where noted, preauthorization requests for pharmacy medications may be initiated:


Submitting pharmacy claims

Starting Jan. 1, 2020, Humana Pharmacy Solutions began managing the pharmacy network for Humana’s Medicaid managed care plan in Kentucky. See the notification for updates.

Notification for pharmacy claims submission, PDF opens new window

Network Notices

Introducing Humana Healthy Horizons™ in Kentucky , PDF opens new window

Out-of-Network Claims Payment Policy Update – August 1, 2020, PDF opens new window

Humana Urine Drug Testing (UDT) Policy – July 1, 2020, PDF opens new window

Updated Retrospective Review Policy – August 7, 2020, PDF opens new window

Medicaid and CHIP Provider Relief Fund Application Deadline Extended to August 3, 2020, PDF opens new window

Provider Relief Fund for Medicaid and CHIP Distribution Webinar – July 8, 2020, PDF opens new window

Reinstatement of Prior Authorization Requirements – July 1, 2020, PDF opens new window

Medicaid Bypass List for Medicare Non-Covered Codes – July 1, 2020, PDF opens new window

Targeted Case Management Prior Authorization Notice - April 1, 2020, PDF opens new window

Provider Relations Representative Assignments

Provider Relations Representative Assignment List, PDF opens new window

Provider Relations Representative Assignment Map by County , PDF opens new window

New Horizon Kentucky Medicaid Provider Newsletter

New Horizon Kentucky Provider Newsletter, PDF opens new window

New Horizon Kentucky Provider Newsletter Archive, PDF opens new window

Annual compliance training materials for healthcare providers

The Centers for Medicare & Medicaid Services (CMS) and state Medicaid contracts mandate that all Humana-contracted physicians and other healthcare providers complete compliance program requirements. Healthcare providers can complete this requirement online at the Availity Web Portal (registration required). Please refer to the following for more information:

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

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

Compliance requirements for healthcare providers who are unable to register online, PDF opens new window

Additional training for Kentucky Medicaid Providers

KY Medicaid Orientation and Training Module, PDF opens new window