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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.

Provider examines toddler while mother watches

The Ohio Department of Medicaid Next Generation Medicaid program

The Next Generation Medicaid program in Ohio will launch in phases throughout 2022. This phased approach will help ensure continuity of care, limit confusion, honor member choice and reduce potential complexities tied to the anticipated end of the federal public health emergency.

On July 1, OhioRISE will begin to provide coordination and specialized services to help children and youth with behavioral health needs who receive care across multiple systems.

On October 1, 2022, Gainwell Technologies, the Single Pharmacy Benefit Manager (SPBM), will begin providing pharmacy services across all managed care plans and for all members.

Also on October 1, ODM will launch the Provider Network Management (PNM) module and Centralized Credentialing, which will reduce administrative burden on providers.

To prepare for these changes, providers should set up their OH|ID and associate their existing accounts. Through September 23, you can access the OH|ID Pre-registration site. The OH|ID is necessary for anyone that will access the PNM or SPBM modules. Establishing login credentials during pre-registration will ease the transition and prevent disruptions to system access for providers ahead of the October 1 launch.

In preparation for the launch of the PNM and SPBM, ODM is offering a variety of trainings. These trainings are a great opportunity for providers to gain knowledge that will benefit our members.

Learn about available PNM and SPBM trainings

During the last three months of 2022, ODM will complete the launch of its Next Generation Medicaid program. That means Medicaid recipients in Ohio can choose Humana Healthy Horizons® in Ohio as their health plan.

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.

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, 8 a.m. – 6 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