D.0 Pharmacy commercial payer sheet
D.0 Pharmacy Medicare payer sheet
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 the above requirements:
Humana’s Ethics Every Day for contracted healthcare providers and business partners (standards of conduct)
Fraud, waste and abuse (FWA) training and general compliance training
As required by 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 2 options to access the CMS training content:
Please note: If organizations choose option 2, the WBT option, they 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, the online NCPDP attestation still must be completed.
Instructions for accessing and completing the NCPDP attestation are included in the following guidance documents:
Deemed providers: Please refer to these , PDF opens new window for more information about the FWA training requirement.