D.0 Pharmacy Payer Sheet View the NCPDP Version D.0 Commercial Payer Sheet - English (325 KB).
D.0 Pharmacy Payer Sheet View the NCPDP Version D.0 Medicare Payer Sheet - English (344 KB).
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).
Medicaid and Duals Pharmacy provider manual Download the full manual - English (1.1 MB).
Download specific sections of the manual:
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 information below is provided to help pharmacies complete these requirements:
Humana’s Ethics Every Day for Contracted Health Care Providers and Business Partners
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.
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
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)
Pharmacy Audit Guide Download our Pharmacy Audit Guide - English (306 KB).
Humana Pharmacy Solutions audit discrepancy code list This list explains discrepancy codes used in pharmacy audit reports..
Prescription Drug Claim Form General form used to submit pharmacy benefits claims - English (200 KB).
Member Eligibility Query Download a guide for retrieving member eligibility - English (69 KB).
Long Term Care Appeal for Untimely Filing Download a resource for untimely filing for pharmacies - English (129 KB).
Long-Term-Care Pharmacy Documentation Guidelines Pharmacy Documentation Guidelines - English (102 KB)