Payer sheets

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:

  • 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 health care providers and business partners (Standards of Conduct) – English

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

Fraud, waste and abuse (FWA) training

Training on combating fraud, waste and abuse 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. Content to meet this component of compliance program requirements may be developed by pharmacies. Pharmacy training materials may be supplemented with content from the above-listed Humana documents.

Manuals and forms

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