Payer sheets

Compliance training 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 training requirements that include, but are not limited to, those outlined by:

  • 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:

Compliance policy

Compliance policy for contracted healthcare providers and third parties – English, PDF opens new window

Compliance policy for contracted healthcare providers and third parties – Puerto Rico – Spanish, PDF opens new window

Humana’s Ethics Every Day for contracted healthcare providers and third parties (standards of conduct)

Ethics Every Day – English, PDF opens new window, Ethics Every Day for contracted healthcare providers and business partners (Standards of Conduct) – English

Ethics Every Day – Spanish, PDF opens new window, Ethics Every Day for contracted healthcare providers and business partners (Standards of Conduct) – Spanish

Fraud, waste and abuse (FWA) training and general compliance training

Training on these topics is required by CMS and state Medicaid contracts for Humana network pharmacies supporting Humana’s plans for Medicare beneficiaries and Humana-administered plans for Medicaid or dual-eligible (Medicare and Medicaid) beneficiaries.

Your organization is responsible for developing or adopting other content to meet these separate training requirements. The training must be provided to those supporting Humana upon contract and annually thereafter. Humana does not require a contracted pharmacy to submit an attestation to confirm compliance with either of these two training requirements. However, Humana reserves the right to require supporting documentation and evidence that a sufficient process is in place to conduct and track the training.

Note: Attestations may be required for other trainings.

Manuals and forms

Provider manuals Controlled substances Medicaid training resources Audit guide, claim form and other materials Network request forms