Provider compliance training materials

The following provider training modules must be completed annually by healthcare providers who participate with Humana Medicare Advantage, Humana Medicaid or Humana Medicare-Medicaid dual plans.

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

• Fraud, Waste and Abuse (FWA) – FWA training is still required. However, effective Jan. 1, 2019, the Centers for Medicare & Medicaid Services (CMS) dropped its requirement that sponsors, such as Humana, confirm contracted providers’ adherence to CMS-issued general compliance and FWA training by collecting an attestation from them. However, under their CMS contracts, plan sponsors remain obligated to conduct oversight, which can include routine monitoring and/or auditing. Humana reserves the right to request evidence, at any time, that compliance and FWA training are occurring and tracked, and that the contractor has processes in place to ensure adherence.

  Please refer to the Frequently Asked Questions and Answers document below for additional guidance on this requirement.

For providers serving Humana special needs plans (SNP) training

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.

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

• Missouri
• New York
• North Carolina

For providers serving Humana Medicaid plans in Florida and Illinois

If you are you contracted to provide services for a Medicaid plan administered by Humana in Florida or Illinois, 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.

1. Medicaid Orientation Training
   • Florida, PDF opens new window
   • Illinois, PDF opens new window
2. Medicaid Provider Training
   • Illinois, PDF opens new window
3. Health, Safety and Welfare Training
   • Florida and Illinois, PDF opens new window
4. Cultural Competency Training
   • Florida and Illinois, PDF opens new window

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 with whom 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 only through 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 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 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:

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

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, 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.