manuals-forms

Pharmacy manuals and forms

Access forms, manuals and other pharmacy reference material.

Provider manual

You can download the entire Humana Pharmacy Solutions Pharmacy Provider Manual or specific sections only.

Pharmacy provider manual Download the full manual - English (9.1 MB).

Download specific sections of the manual:

Compliance requirements

Pharmacies contracted with Humana or Humana subsidiaries to support Humana Medicare Advantage and Prescription Drug Plan programs, Medicaid plans and/or dual Medicare-Medicaid plans must complete compliance requirements that include, but are not limited to, those outlined by:

  • The Centers for Medicare & Medicaid Services (CMS): Upon initial contract and annually thereafter for Medicare-related offerings
  • Contractual arrangements with states where Humana offers Medicaid and/or dual Medicare-Medicaid plans: Annually (when applicable)

The information below is provided to help pharmacies complete these requirements:

Compliance Policy

Compliance Policy for Contracted Health Care Providers and Business Partners - English (2.24 MB)

Compliance Policy for Health Care Providers and Business Partners Puerto Rico - Spanish (2.3 Mb)

Humana’s Ethics Every Day for Contracted Health Care Providers and Business Partners

Ethics Every Day for Contracted Health Care Providers and Business Partners - English (686 KB)

Ethics Every Day for Contracted Health Care Providers and Business Partners - Spanish (3.1 Mb)

Fraud, Waste and Abuse Training and General Compliance Training

As required by the Centers for Medicare & Medicaid Services (CMS) and state Medicaid contracts, Humana has adopted CMS-published training content that includes this subject matter. For purposes of first-tier, downstream and related entities’ (FDRs) relationships with Humana, this training, including all references and requirements related to Medicare Part C and Part D, is applicable to all Humana lines of business. This includes commercial, Medicare Part C and Part D, dual Medicare-Medicaid and Medicaid.

Humana network pharmacies supporting Humana’s plans for Medicare, Medicaid or dual-eligible (Medicare and Medicaid) beneficiaries must use the CMS training content to meet this component of compliance program requirements, although pharmacies may supplement the CMS training with their own material.

Accessing the CMS Training Content

There are two options to access this material:

- Through downloadable PDF documents; or

- Via two interactive Web-based training (WBT) modules on the CMS Medicare Learning Network Additionally, organizations choosing the WBT option can receive a CMS certificate of completion from CMS for each module. While organizations may pursue this approach and provide Humana with the CMS certificates, Humana’s attestation still must be completed.

Deemed providers: Please refer to this FAQ for more information about the FWA training requirement.

Accessing the CMS Training File

  1. Navigate to http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/ProviderCompliance.html (link opens in new window) .
  2. Scroll to the “Downloads” section.
  3. Click on “Medicare Parts C and D Fraud, Waste, and Abuse Training and Medicare Parts C and D General Compliance Training.”
  4. Follow the instructions in the CMS file to access the CMS content in your organization’s preferred method.

Humana Orientation Training for Pharmacy Providers Humana Orientation Training - English (544 Kb)

Health, Safety and Welfare Education Training Health, Safety and Welfare Education Training - English (3.43Mb)

Cultural Competency Training Cultural Competency Training - English (3.43Mb)

Medicaid Pharmacy Provider Training Medicaid Pharmacy Provider Training - English (582 Kb)

2016 Compliance Requirements Attestation Form for Pharmacy Providers 2016 Compliance Requirements Attestation Form for Pharmacy Providers - English (582 Kb)

2016 Compliance Requirements FAQ for Pharmacy Providers 2016 Compliance Requirements FAQ for Pharmacy Providers - English (305 Kb)

Audit guide, claim form and other materials

Network Materials

Pharmacy Contract Request Form Pharmacy Contract Request Form - English (388 KB).

Pharmacy Pricing Review Request Pharmacy Pricing Review Request - English (67 KB).