The following provider training materials are available for contracted users:
- Compliance Policy for Contracted Healthcare Providers and Business Partners
- Ethics Every Day for Contracted Healthcare Providers and Business Partners (Standards of Conduct)
- General Compliance training and Fraud, Waste and Abuse (FWA) training (via published content from the Centers for Medicare & Medicaid Services [CMS])
- Special Needs Plans (SNP) training (if the contracted party has one or more practitioners participating in any Humana Medicare health maintenance organization [HMO] network in one of the following states or territories: Alabama, California, Colorado, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, Nevada, New York, North Carolina, Ohio, Pennsylvania, Puerto Rico, South Carolina, Tennessee, Texas, Virginia or Washington)
- Medicaid-specific trainings (if the contracted party is supporting the Humana Florida Medicaid plan [identified on member ID cards as Humana Comprehensive plan, Humana Long-Term Care plan and/or Humana Medical plan] or Humana Gold Plus® Integrated [Medicare-Medicaid plan] in Illinois), its training may include any or all of the following, depending on the state: Florida or Illinois Humana Orientation Training, Medicaid Provider Training, Health, Safety and Welfare Training and Cultural Competency Training)
Humana recognizes that practitioners enrolled in the Medicare program or accredited as a durable medical equipment, prosthetics, orthotics and supplies (DME POS) provider are deemed to have met the FWA training and education requirements. In this situation, a contracted party’s representative will have an opportunity to record how it meets the FWA training requirement and affirm its use of the CMS content for general compliance training of its employees, and, if applicable, nonemployees contracted as individuals or working for a subcontracted entity that supports a Humana contract.
However, deemed practitioners are still responsible for adhering to the requirements outlined in the compliance policy, business ethics, general compliance training and (if applicable) Medicaid and SNP components of the training. Therefore, a contracted party with one or more deemed practitioners must attest to compliance with these above-listed trainings. More information is available in the , PDF opens new window
Why the training is required and how to complete the required compliance attestation
The review and confirmation of these training materials help practitioners abide by state and federal law and Humana's policies and procedures to comply with government requirements. Therefore, contracted parties must share the required information with their employees and, when applicable, with nonemployees they contract as individuals and any subcontracted entities that support a Humana contract.
The attestation is intended to 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 through only a group contract, the practitioner will need to coordinate within the organization to have the person responsible for compliance complete the required attestation. Please note that if an organization provides multiple functions for Humana, its compliance contact may receive an additional notification from Humana; the organization is only required to complete this attestation once per year.
Any contracted party needing to complete the attestation may do so online via Humana's secure compliance website. To access the website, the contracted party represented must be registered on , opens new window
The information below can help you meet the requirement:
This document provides additional information regarding the compliance requirements and related online resources.
This document covers the process of completing the compliance requirements on Availity.com, including how to register on Availity.com, 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:
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 1-877-5THE KEY (1-877-584-3539), the , 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.