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:

  • 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:

Compliance policy

Compliance policy for contracted health care providers and business partners – English, PDF opens new window

Compliance policy for contracted health care providers and business partners – Puerto Rico – Spanish, PDF opens new window

Humana’s Ethics Every Day for contracted healthcare providers and business partners (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 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 FAQs, PDF opens new window for more information about the FWA training requirement.

Manuals and forms

Provider manuals Medicare training resources Audit guide, claim form and other materials Network request forms