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Provider Network Management and Single Pharmacy Benefit Manager

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

Compliance training materials

The Centers for Medicare & Medicaid Services and state Medicaid contracts mandate that all Humana-contracted healthcare providers complete compliance trainings each year. You’ll find these required annual trainings below. After you complete the Humana Healthy Horizons® in Ohio Orientation and Training Module, please complete and submit an attestation to let us know.

Trainings also are available Online at Availity (registration required)

If you have questions, please call us at 877-856-5707 (TTY: 711), Monday – Friday, 7 a.m. – 8 p.m., Eastern time.

2022 Humana Healthy Horizons in Ohio Orientation and Training Module , PDF

This training includes information about Humana and Humana Healthy Horizons in Ohio, covered services, expanded services, contracting and credentialing, access-to-care requirements, preauthorization and notification, and other key topics we want our providers to have. We base these topics on our contract with the Ohio Department of Medicaid and on current Humana policies and procedures.

Cultural Competency Training , PDF

This training includes information about culture, cultural competence, clear communication, various subcultures and populations, strategies for working with seniors and people with disabilities, and additional information we want our providers to have.

Health, Safety, and Welfare Education Training , PDF

This training includes information about abuse; neglect; exploitation; interventions; “handle with care” measures; reporting abuse, neglect, or exploitation; rights of mandated reporters; general reporting requirements; critical incidents; and information about Ohio agencies.

Download, print, and submit your attestation of completion , PDF

The attestation form lets you confirm completion of all three required trainings.

For more information about these required annual trainings and completing trainings via Availity:

Compliance Requirements for Healthcare Providers—Answers to Frequently Asked Questions , PDF

Completing training via Availity , PDF

Completing trainings manually , PDF

Additional resources

Relias

Humana Healthy Horizons in Ohio providers have access to Relias—a web-based library available through your secure Availity account.

Through Relias, you can explore topics like:

  • Addiction
  • Behavioral health
  • Integrated care
  • Mental health

To access the Relias library, please:

  • Sign in to your Availity account
  • Select Humana under the Payer Spaces tab
  • Select the Resources tab
  • Select Relias Behavioral Health Training

These behavioral health-focused training modules provide integrated information to support comprehensive care and address unique member needs. The extensive Relias library is comprised of courses designed to improve the likelihood of success in the emerging value-based healthcare delivery system. You also can earn continuing education credits by completing these courses.

Altruista (population health module)

Altruista is our population health module. This module helps physicians monitor clinical measures identified and executed for members assigned to their panel. Access this module by:

  • Signing in to Availity
  • Navigating to the Humana Payer Spaces section
  • Selecting Resources

The Ohio Medicaid Care Management link will direct providers to the population health dashboard. This allows providers to view member assessments, care plans, authorizations, assigned care management programs, and contact information for the member’s care manager.