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Humana Healthy Horizons in Ohio

We are proud to partner with the Ohio Department of Medicaid (ODM) as it launches its Next Generation Medicaid program to help improve wellness and health outcomes for Medicaid recipients in Ohio.We include below important information for all Ohio Medicaid providers.

Provider examines toddler while mother watches

Attention all Ohio Medicaid providers

November 2022 update: ODM announced that its Next Generation Medicaid program now will launch on Feb. 1, 2023. This will help ODM and its managed care plan partners – including Humana Healthy Horizons® in Ohio – ensure a smooth transition for providers and Medicaid recipients.

The Feb. 1 launch, according to ODM, will coincide with improvements to how Medicaid recipients access healthcare services and supports they need. ODM also will implement the new Electronic Data Interchange (EDI), increasing transparency and visibility of member care and services.

After, ODM will fully launch the full Ohio Medicaid Enterprise System (OMES) module to provide streamlined processes for claims, prior authorizations, and other administrative tasks for providers.

Until that time, providers serving Medicaid recipients in Ohio should continue conducting business as they do today, including the processes, procedures, and systems they use to submit claims and prior authorizations and to complete other administrative functions.

There will be no disruption in services for members.

Member who select (or selected) a Next Generation managed care plan – like Humana Healthy Horizons in Ohio – will start receiving services from that plan on Feb. 1.

ODM will send notices to providers about learning and training opportunities on various aspects of the Next Generation Program either via the mail and/or through announcements on the ODM website

Need help?

Get information about who to contact depending on the help you need, PDF

Introducing Humana Healthy Horizons in Ohio

Humana Healthy Horizons has served Medicaid populations continuously for more than 2 decades and currently manages Medicaid benefits for nearly 800,000 members nationally. We developed expertise providing care management, care planning, and specialized clinical management for the complex needs of members within a social supports‐based framework.

We also developed significant expertise in integrating physical health, behavioral health, pharmacy and social services and supports for a whole-person centered approach to improve the health and well‐being of our members and the communities we serve.

In Ohio, Humana already serves 568,000 residents through Medicare Advantage, Medicare prescription drug plans, commercial employer-sponsored plans, commercial dental and vision coverage, and TRICARE.

For more than two decades, Humana has served Medicaid populations and currently manages Medicaid benefits for nearly 800,000 enrollees nationwide. Humana Healthy Horizons is committed to continue demonstrating our ability to manage complex populations and create solutions that lead to a better quality of life for our members.

We are pleased to announce that Humana Healthy Horizons in Ohio is launching in early 2022. In partnership with the Ohio Department of Medicaid, we will work with our provider network to serve our members in Ohio, and help them reach their health goals and get the right care in the right place at the right time.

Helping keep our members in their best health is what human care is all about.

Join our network

By working closely with our providers, we can help our members in Ohio:

  • Develop strong relationships with their primary care provider
  • Get the right care in the right place at the right time
  • Set and reach health goals

Once ODM completes implementation of its Next Generation Medicaid program, Humana Healthy Horizons in Ohio will administer care focused on Temporary Assistance for Needy Families, Expansion, and Assisted, Blind, and Disabled populations in the west, northeast, and central/southeast regions.

For additional information about joining our network:

Email: OhioNetworkSpecialist@humana.com

Call: 877-856-5707, Monday – Friday, 7 a.m. – 8 p.m., Eastern time

About Humana Healthy Horizons in Ohio

Nationally, we serve Medicaid members through:

  • Medicaid Managed Care (MMC)
  • Managed Long-term Services and Supports (MLTSS) programs
  • Centers for Medicare & Medicaid Services (CMS) Financial Alignment Initiative Dual Demonstrations
  • Medicare Advantage (MA)
  • Dual Special Needs Plans (D-SNPs)
  • Prescription drug plans (PDPs)

Humana Healthy Horizons in Ohio is a Medicaid product of Humana Health Plan of Ohio Inc.

Provider resources

We want to make working with us as easy as possible. We make available the key documents and forms you need to work with us and get paid. Check out the Humana Healthy Horizons in Ohio Provider Manual, PDF, learn about our claims process, get answers to frequently asked questions, and more.

See a sample network provider contract by provider type, PDF