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Provider documents and resources

These documents apply to all counties where Humana Healthy Horizons in Ohio coverage is available.

Attached is the Clinical Trial form, PDF. Please complete and return with any prior auth request for care related to a clinical trial.

2022-2023 Humana Healthy Horizons in Ohio Provider Manual – effective December 1, 2022, PDF

2022 Humana Healthy Horizons in Ohio Provider Resource Guide , PDF

Visit the Humana Healthy Horizons in Ohio unsecure member website

Access the ODM searchable provider directory

Access a searchable provider directory via our online Find a Doctor service

Access the social determinants of health Ohio provider guide, PDF

Social Determinants of Health (SDOH) Data with ICD-10-Cm Z Codes CMS Resource Guide, PDF

Z Codes CMS Infographic – Using Z Codes, PDF

Ohio Department of Medicaid forms

Ohio Medicaid Provider Agreement, PDF

Ohio Medicaid Behavioral Health State Plan Services – Provider Requirements and Reimbursement Manual, PDF

Out-of-network provider application, PDF

SUD Residential treatment notification of admission form, PDF

Access the Ohio Department of Medicaid forms website

Change PCP form

You and your patient must sign the Change PCP form when submitting a request for a patient in your panel to choose you as their PCP instead of the PCP they have.

Change PCP form, PDF

Abortion, sterilization, and hysterectomy forms

When submitting an abortion, sterilization, and/or hysterectomy procedure claim, please attach the appropriate consent form.

ODM Abortion Certification , PDF

Consent for Sterilization – English , PDF

Consent for Sterilization – Spanish , PDF

Acknowledgement of Hysterectomy – English , PDF

Acknowledgement of Hysterectomy – Spanish, PDF

Notification of birth

Please use our Notification of birth form to let us know when one of your patients with Humana Healthy Horizons in Ohio coverage gives birth. Use this form to report a single birth as well as the delivery of twins or triplets. We will use this information to get a newborn Medicaid ID for each baby.

Notification of birth form , PDF

Nursing facility request form

Please submit the Ohio Medicaid Managed Care/MyCare Ohio Nursing facility request form to ask us to review your request for admission to a nursing facility. We will be unable to complete a medical necessity and level of care determination without receiving all required supporting documentation.

Access a Nursing facility request form from the ODM website, PDF

When completing the form, please select Humana from the dropdown under Managed Care Entity Contact Information.

Humana clinical practice guidelines

Clinical practice guidelines for healthcare providers

Behavioral health guidelines

Pharmacy resources

Gainwell (Single Pharmacy Benefit Manager)

Review the current ODM Unified PDL Forms

Other resources

Provider relations representative assignments, PDF

Provider relations representative assignments by county, PDF

Communicating with Humana Healthy Horizons in Ohio

Provider relations: 877-856-5707 (TTY: 711), Monday – Friday, 7 a.m. – 8 p.m., Eastern time

24-Hour Nurse Advice Line (24/7, 365 days a year): 866-376-4827

Prior authorization for pharmacy drugs: 800-555-2546

Medicaid case management: 877-856-5707

Availity customer service/tech support/medical and behavioral health prior authorization submission support: 800-282-4548

Fraud, waste, and abuse

  • Special Investigations Unit (SIU) hotline: 800-614-4126 (24/7 access)
  • Ethics Help Line: 877-5-THE-KEY (584-3539)

Humana Provider Relations

Grievance and Appeal Department
P.O. Box 14546
Lexington, KY 40512-4546
Fax: 800-949-2961


Members can obtain transportation through Humana Healthy Horizons’ Non-Emergent Medical Transportation vendor Access2Care by calling 855-739-5986. Members may also contact the Medicaid Transportation Coordinator at the local county department of job and family services (CDJFS). The main phone number for each CDJFS is included in a list available at; select County Directory.


Humana has contracted with DentaQuest to provide members with routine and value added dental benefits.

Credentialing hotline: 800-233-1468


Humana has contracted with EyeMed to provide members with routine and value-added vision benefits.

Apply for the Ohio Medicaid network
Complete the online join form
Complete the application and indicate “Ohio Medicaid Network” in the “Additional Comments” field at the bottom of the form

For more information: