Region 1: Escambia, Okaloosa, Santa Rosa and Walton counties
Region 6: Hardee, Highlands, Hillsborough, Manatee and Polk counties
Region 9: Indian River, Martin, Okeechobee, Palm Beach and St. Lucie counties
Region 10: Broward County
Region 11: Miami-Dade and Monroe counties
Medicaid Long-term-care Managed Care Program
Thank you to the providers who participate with the Humana Long-Term Care Plan provider network and provide quality, accessible services to our members throughout Florida.
This page is designed to give providers quick access to current information 24 hours a day, seven days a week. In addition, providers will find useful information about other Humana Long-Term Care programs and resources.
Humana Long-Term Care has improved online tools that became available on Aug. 1, 2016, including tools that give you the ability to submit claims or invoices electronically through the Availity Web Portal. To register for a demonstration of the online options available to you via Availity, please visit the Provider Training Calendar (link opens in new window) and select the date you want to attend to begin the online registration process.
Providers already registered with Availity can sign in to the secure Availity provider website here and select “Login.”
To register for the Availity portal, or for information about registering or working with Availity, go to www.availity.com/humana. As of Sept. 1, 2016, the Humana Long-Term Care Provider Portal is read-only. Providers can continue to check the status of claims already submitted but need to use the Availity portal to submit new transactions.
Find updated contact information for our regional provider contracting representatives here (link opens in new window).
Providers can find more information about the Medicaid Long-term-care Managed Care Program (link opens in new window).
Additional helpful information:
Annual compliance training materials for health care providers
The Centers for Medicare & Medicaid Services (CMS) and state Medicaid contracts mandate that all Humana-contracted health care providers complete compliance program requirements. Health care providers can complete this requirement online at the Availity Web Portal (registration required), the Humana.com secure provider website (registration required) or manually using the “Training Requirements for Health Care Providers Who Are Unable to Register” link below. Please refer to the following for more information:
Additional training materials for health care providers
Humana supports all communities – Humana makes every effort to recruit and retain physicians and health care professionals of all ethnicities in order to support the cultural preferences of our members. Currently, Humana’s Medicaid provider networks are open to new physicians and health care professionals who are willing to accept our contractual requirements and rates, as well as satisfy all credentialing and regulatory requirements.
We review and accommodate all provider nomination requests, when appropriate, from both members and others to facilitate equal representation in our provider network. Physicians may contact their provider relations representative to nominate a provider or complete the provider nomination form.
PLEASE NOTE: Physicians and health care professionals are encouraged to work with their provider relations representative to ensure Humana accurately reflects the languages spoken in their offices in Humana’s provider directories.
Humana Florida Medicaid Vaccines for Children (VFC) Program and Child Blood Lead Screening – As part of Humana’s focus on preventive health, we want all infants and children to receive recommended immunizations and screenings.
Additionally, as detailed under section 1905(r)(1)(B)(iii) of the Social Security Act, Humana is required to remind physicians regarding their participation in the Vaccines for Children (VFC) program. More information regarding ordering VFC program vaccines is available on the Florida SHOTS™ website at http://flshotsusers.com.
Federal regulations also require that children receive a blood screening for lead at 12 months old and at 24 months old.
If you have questions regarding the VFC program or blood lead screenings, please contact the Humana Quality Management department at 1-305-626-5252.
Humana updates Child Health Check Up billing guidance – Practitioners can now bill Humana for a Child Health Check Up and a sick visit for the same date of service. Physician discretion in evaluating the degree of illness should determine if a Child Health Check Up should be performed during a visit when the child is sick.
A Child Health Check Up should not be performed on an obviously sick child, as the findings may be distorted. In these instances, it is advised that the physician treat the child for the illness and reschedule the check up. If, in the physician’s opinion, a Child Health Check Up or well-child visit can be appropriately completed, the physician is encouraged to treat or refer the child for the illness and bill the Child Health Check Up or well visit.
For questions, please contact your Humana or IASIS provider relations representative.
Smoking cessation – As part of our Healthy Behaviors program, Humana has contracted with Beacon Health Options 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.
Beacon Health Options 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.
The following documents provide important resources for health care providers specific to Florida Medicaid members:
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 (link opens in new window) (registration required).
LTSS providers who need information regarding claims status or to enter claims for services provided July 1, 2015, through Aug. 31, 2016, can access the Humana Long-Term Care LTSS provider portal (link opens in new window) (registration required). If you have questions, please contact Humana Long-Term Care at 1-561-665-4415 or via email at LTCproviderrelations@humana.com.