florida

Humana Managed Medical Assistance (MMA) program provider materials

Humana has contracted with the Agency for Health Care Administration (AHCA) to provide services to Medicaid beneficiaries through Humana Managed Medical Assistance (MMA) plans. Medicaid provides health care coverage for income-eligible children, seniors, disabled adults and pregnant women. It is funded by both the state and federal governments.

Provider Materials

Humana MMA health care provider communications and AHCA information bulletins

The following materials provide the latest Humana MMA plan information for health care providers:

  • Medicaid Eligibility for Newborn Babies (58Kb) – This communication was published by ACHA on April 17, 2015, to provide information regarding the following topics related to newborn baby eligibility:
    • Unborn activation process
    • Enrollment in an MMA plan
    • Enrollment in an MMA specialty plan
    • Voluntary change of MMA plan for the baby
    • No enrollment in the MMA plan for the mother
    • How to request a Medicaid number for the baby
  • First Quarter 2015 Update for Physicians and other Health Care Providers (409 Kb) – This publication provides updates for Humana Family Medicaid HMO network physicians and health care providers in Florida.

    Topics include:

    • 2015 compliance training requirements
    • Affordable Care Act primary care fee
    • Medicaid-specific materials on Humana’s provider website
    • Secure Web options via Availity
    • Humana's substance abuse program from Psychcare
    • Humana-Psychcare smoking cessation program
    • Medicare Advantage members who have enrolled in an MMA plan
    • Humana Family FIT
    • Vaccines for Children program
    • Medicaid family planning services
    • Child Health Checkup screenings
    • Claims submission errors
    • After-hours availability
    • Authorization process for OB/GYNs
    • Encounter submissions for Medicaid
    • What's new for Medicaid obstetricians
  • Medicaid-participating obstetricians and gynecologists training (825 Kb) – This orientation presentation covers topics specific to obstetricians and gynecologists who serve Humana Managed Medical Assistance (MMA) plans.
  • Affordable Care Act Primary Care Fee Increase – Section 1202 of the Patient Protection and Affordable Care Act (ACA) authorized a physician fee increase effective for dates of service from Jan. 1, 2013, through Dec. 31, 2014. Since the federal government has not extended this increase, Florida Medicaid physician fees no longer include the ACA rates effective Jan. 1, 2015.
    Medicaid managed care plan providers should refer to their contract with each plan to determine whether this change will impact reimbursement.
  • Healthy Behaviors – The following Healthy Behaviors programs are offered to MMA members:
    • Smoking cessation
    • Substance abuse
    • Humana Family Fit
    • Mom’s First
    • First baby well visit
    • Lead screening and well-child visit
    • Children’s nutrition
    • Adolescent well-child visit
  • Smoking cessation – As part of our Healthy Behaviors program, Humana has contracted with Psychcare to provide a telephonic smoking cessation counseling program for Humana MMA members. Members may self-refer or be referred by their health plan or physician by calling 1-800-221-5487.

    Psychcare will facilitate member enrollment via its Encompass Program, assigning the member a care coordinator or care manager. Members will be engaged in treatment with community practitioners, online and face-to-face support groups, as well as other resources that facilitate a smoke-free lifestyle. This combination of counseling and medication has shown to provide the greatest likelihood of successful treatment.

    Find useful information for primary care physicians regarding treating tobacco use and dependence from the Agency for Healthcare Research and Quality Agency.

  • Guidance for Prescribing a Psychotropic Medication for a Child in the Medicaid Program (66.7Kb) – This letter was distributed in September 2011 to pediatricians and family practice primary care physicians who treat pediatric Medicaid patients in South Florida. The letter advises physicians about a change in Florida law that requires health care providers to have express and informed consent from a parent or legal guardian when prescribing psychotropic (psychotherapeutic) medication for a child in the Medicaid program.
  • Coverage of Topical Fluoride Varnish for Children with Medicaid (57.9Kb) – This communication was distributed to pediatricians, primary care providers and family medicine physicians in the South Florida market in June 2011 to describe a change in plan benefits for Humana Family Medicaid members.

Quality resources

  • The following documents provide important resources for health care providers specific to Florida Medicaid members:

    Long-term services and supports (LTSS) provider portal

    Long-term services and supports (LTSS) providers who need information regarding eligibility, authorizations and claims status for services provided before July 1, 2015, can access the Independent Living Systems (ILS) LTSS provider portal (registration required).

    LTSS providers who need information regarding eligibility, authorizations and claims status for services provided on July 1, 2015, and after, can access the Humana American Eldercare LTSS provider portal (registration required).