Provider compliance training materials

The following training modules must be completed annually by healthcare providers who participate with Humana Medicare Advantage; Humana Medicaid, including Humana Healthy Horizons in Kentucky; and/or Humana Medicare-Medicaid dual special needs plans. Read below to determine which modules apply to your practice.

For providers serving Humana special needs plans (SNP)

Only providers serving patients with Humana Medicare preferred provider organization (PPO) and health maintenance organization (HMO) plans in certain states and territories must take special needs plans (SNP) training.

Healthcare providers serving Humana Medicare PPO members in these states are required to take SNP training:

• Arkansas
• Missouri
• New York
• North Carolina
• West Virginia

For providers serving Humana Medicaid plans in Florida, Illinois and/or Kentucky

If you are contracted to provide services for a Medicaid plan administered by Humana in Florida, Illinois and/or Kentucky, you are required to take the modules cited below. Your training may include any or all of the modules, depending on the state(s) in which you are contracted.

• 2021 Humana Medicaid Provider Orientation Training
  • Florida, PDF opens new window
  • Illinois, PDF opens new window
• Medicaid Provider Training
  • Illinois, PDF opens new window
• Medicaid Training and Orientation
  • Kentucky, PDF opens new window
• Health, Safety and Welfare Training
  • Florida, Illinois and/or Kentucky, PDF opens new window
• Cultural Competency Training
  • Florida, Illinois and/or Kentucky, PDF opens new window

Review and confirmation of the SNP and Medicaid-related training materials help practitioners comply with state and federal law, other government requirements and Humana's policies and procedures. Therefore, applicable parties must share the required information with their employees and, when applicable, with nonemployees with whom they contract as individuals and any subcontracted entities that support any of the following Humana plan types: Medicare, Medicaid, and/or Medicare-Medicaid dual special needs plans.

There are separate attestations for SNP training and the Medicaid states, but each attestation should be completed at the contract level. That is, each practitioner in an organization with a direct contract with Humana must separately complete the required attestation. However, if a practitioner is contracted with Humana only through a group contract, the organization will need to have a person responsible for compliance complete the required attestation. Please note that if an organization performs multiple functions for Humana, its compliance contact may receive an additional notification from Humana; the organization is only required to complete each applicable attestation once per year.

Any contracted party needing to complete a Humana attestation may do so online via Humana's secure compliance website. To access the website, the contracted party represented must be registered on Availity.com., opens new window

The information below can help you meet the requirement:

Frequently asked questions and answers, PDF opens new window

This document provides additional information regarding the compliance requirements and related online resources.

Availity.com instructions, PDF opens new window

This document covers the process for completing compliance requirements on Availity.com, including how to register, how to create a new user, how to assign the compliance business function to another user and how to update an organization's Tax Identification Number.

If your organization is unable to register on Availity.com, refer to the following document:

Compliance Requirements for Contracted Healthcare Providers Who Are Unable to Register Online, PDF opens new window

• Ethics Every Day for Contracted Healthcare Providers and Third Parties (Standards of Conduct), PDF opens new window
• Compliance Policy for Contracted Healthcare Providers and Third Parties, PDF opens new window

• Fraud, Waste and Abuse (FWA)

  If your organization supports Humana’s Medicare Advantage plans, prescription drug plans and/or Medicaid plans, CMS and Humana require that your employees be trained on FWA at orientation and annually thereafter.

  Your organization can create and train on its own FWA content, or it can use content provided on CMS’ website. Supplemental material for addressing FWA is available in Humana’s Ethics Every Day and Compliance Policy documents, above.

  *Important: Humana reserves the right to request evidence at any time that an organization’s FWA training is occurring, that the organization is tracking the training, and that the organization has documented processes for the training and tracking.

Please remember to complete the compliance requirements within 30 days of notification.

If a practitioner, or anyone employed by or contracted with a provider contracted with Humana, suspects actions of noncompliance and/or fraud, waste and abuse, he or she must report it immediately. This may be done confidentially via the Ethics Help Line at 877-5THE KEY (877-584-3539), the Ethics Help Line web reporting, opens new window site or a separate, preferred method of the contracted party that must then forward the information to Humana in a timely manner.