manuals-forms

Pharmacy manuals and forms

Access forms, manuals and other pharmacy reference material.

Payer sheets

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).

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 requirement materials

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 (3.43Mb)

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 (1.74 MB)

Ethics Every Day for Contracted Health Care Providers and Business Partners - Spanish (6.4 Mb)

General Fraud, Waste and Abuse Detection, Correction and Prevention Training

Humana has adopted a training document published by the Centers for Medicare & Medicaid Services (CMS) 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 suggests FDRs use this file to simplify their training process, although they may use another training that is materially similar.

Accessing the CMS Training File

English Version

  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. Select “Open” or “Save” as the training is available in both PDF and PowerPoint formats.

Puerto Rico - Spanish (3.5MB)

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)

2015 Compliance Requirements Attestation Form for Pharmacy Providers
2015 Compliance Requirements Attestation Form for Pharmacy Providers - English (582 Kb)

2015 Compliance Requirements FAQ for Pharmacy Providers
2015 Compliance Requirements FAQ for Pharmacy Providers - English (582 Kb)

Audit guide, claim form and other materials

Pharmacy Audit Guide
Download our Pharmacy Audit Guide - English (306 KB).

Prescription Drug Claim Form
General form used to submit pharmacy benefits claims - English (694 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 (156 KB)