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
Training on combating fraud, waste and abuse is required by the Centers for Medicare & Medicaid Services (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.
Note: Deemed status does not satisfy the fraud, waste and abuse training requirement. Please refer to these , PDF opens new window for more information about the compliance program requirements, including FWA training.