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Answers to FAQs

We know you may have questions about working with Humana Healthy Horizons™ in Ohio. Below, we collect answers to questions we’re frequently asked. If you have a question that we don’t answer below, reach out to us.

Medicaid provider works online

Q. How do I work with Humana Healthy Horizons in Ohio online?

A. Healthcare providers who want to work with Humana Healthy Horizons in Ohio online can register for the Availity portal at no cost. This multipayer portal allows providers to interact securely with Humana Healthy Horizons in Ohio and other participating payers without learning to use multiple systems or remembering different user IDs and passwords for each payer. Many tools specific to Humana Healthy Horizons in Ohio are accessible from the Availity provider portal. To learn more, call Availity at 800-282-4548 or visit Availity.

Q. How do I find out if preauthorization is needed for a patient with Humana Healthy Horizons in Ohio coverage?

A. Humana uses preauthorization for certain services to facilitate care coordination and maximize Humana Healthy Horizons in Ohio patient benefits. The Humana Healthy Horizons in Ohio (Ohio Medicaid) Preauthorization and Notification List does not affect preauthorizations or notifications for Medicare and/or commercial lines of businesses. To determine whether preauthorization is required for a patient with Humana Healthy Horizons in Ohio coverage, healthcare providers should review the Humana Healthy Horizons in Ohio (Ohio Medicaid) Preauthorization and Notification List.

Q. Where can I find a list of the services Humana Healthy Horizons in Ohio covers for its members?

A. Refer to the Humana Healthy Horizons in Ohio Provider Manual, PDF for a full list of the services Humana Healthy Horizons in Ohio covers for its members

Q. Where can I find a list of the services Humana Healthy Horizons in Ohio does not cover for its members?

A. Refer to the Humana Healthy Horizons in Ohio Provider Manual, PDF for a full list of the services not covered by the Ohio Medicaid program. Additional information about noncovered services can be found on the Ohio Department of Medicaid website.

Q. Where can I find information about the Humana Healthy Horizons in Ohio Quality Improvement Program?

A. The Humana Healthy Horizons in Ohio Provider Manual, PDF includes information about the Humana Healthy Horizons in Ohio Quality Improvement Program.

Q. How can I join the Humana Healthy Horizons in Ohio provider network?

A. For answers to questions about joining our Humana Healthy Horizons in Ohio network, please call 877-856-5707 (TTY: 711), Monday – Friday, 7 a.m. – 8 p.m., Eastern time. You also can find more information here.

Q. What protocols, if any, do you have in place to let me know if one of your members on my panel tests positive for COVID-19?

A. We will notify you via the lab section of the care portal upon learning that one of our members in your panel tests positive. Leveraging the care portal for notification will streamline and allow for timely communications between Humana and the individual’s primary care provider (PCP). After notifying the PCP, we also will notify our member that the communication took place.

Q. When does Humana Healthy Horizons in Ohio begin coverage of a newborn when the mom has coverage through Humana Healthy Horizons in Ohio?

A. Humana Healthy Horizons in Ohio begins coverage of newborns on the date of birth when the newborn’s mother is a member of a Humana Healthy Horizons in Ohio Medicaid plan. The delivery hospital is required to enter the birth record into the birth record system, Ohio’s Certificate of Live Birth, Hearing, Immunization, and Lab Data. That information is used to auto enroll the newborn deemed eligible within 24 hours of birth. The newborn then appears on the primary care provider’s (PCP’s) member eligibility list after the information is added to the Humana Healthy Horizons in Ohio system. You can verify eligibility for a newborn on the provider portal at Availity.com. Please refer to the Verify Eligibility section for instructions.

Q. Where can I find information about covered services?

A. The Humana Healthy Horizons in Ohio Provider Manual, PDF includes information about covered services and core benefits, behavioral health and substance-use services, value-added benefits, optional health and wellness programs, and pharmacy coverage.

For additional information

For answers to other questions, call the Humana Healthy Horizons in Ohio Provider Services center at 877-856-5707, Monday – Friday, from 7 a.m. – 8 p.m., Eastern time.