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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 Long-Term Care Plan

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:

Health Care Provider Training Materials

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 provider communications and AHCA information bulletins

  • Crossover claims – Effective Oct. 1, 2016, providers no longer need to send Medicare crossover claims for dually eligible recipients directly to Humana. Under this initiative, providers only need to submit their claims once to the Centers for Medicare & Medicaid Services (CMS) for processing, and are no longer required to submit secondary claims to Humana. This means CMS will automatically forward claims for members who are dually eligible for both Medicare and Medicaid coverage. Please note: If a provider submits a claim for a dually eligible member that CMS has already forwarded to Humana, Humana will deny the provider-submitted claim as a duplicate claim.
  • Abilify Coverage – Effective July 1, 2016, Abilify has been removed from the AHCA preferred drug list. Abilify is considered nonpreferred; however, the generic version of Abilify, aripiprazole, is preferred. Health care providers need to encourage their patients with Humana MMA coverage to switch from brand Abilify to generic aripiprazole. Prescriptions for brand Abilify will not adjudicate since it is nonpreferred. If brand Abilify is needed, the prescriber needs to request an authorization by calling Humana Clinical Pharmacy Review (HCPR) at 1-800-555-2546 or via www.covermymeds.com (link opens in new window) (registration required).
  • Overview of the Federally Qualified Health Center (FQHC)/Rural Health Center (RHC) Wraparound Process – Since the implementation of the automated FQHC/RHC wraparound process, the Agency for Health Care Administration (AHCA) has encouraged providers to continue to work with Statewide Medicaid Managed Care (SMMC) health plans to submit encounters that will generate payments through the automated process. Find more information about these programs via AHCA’s approved training (link opens in new window) and quick reference guide (link opens in new window).
  • Zika Virus Information (link opens in new window) – Access the Florida Health website to find the latest updates on the Zika virus in Florida, including current guidance for clinicians and obstetricians.
  • Sample patient services letters – There are many reasons patients miss the medical services and tests that are valuable to their health. Humana has developed tools physicians can use to help patients with MMA coverage keep current. The adult sample services letter provides a checklist of the recommended health services and tests for adult MMA members, including preventive screenings, medications and diabetes care. The pediatric sample services letter provides a checklist of the recommended health services and tests for pediatric MMA members, including preventive screenings and medications.

    Physicians can:

    1. Download and customize the letter(s) for their letterheads, their communication styles and patients' needs.
    2. Distribute the letter(s) to their MMA-covered adult and/or pediatric patients, regardless of the patients' health benefits plan membership.

    Sample Adult Services Template Letter (198 Kb)

    Sample Pediatric Services Template Letter (195 Kb)

  • Provider-initiated Member Transfer Process (link opens in new window) – This document explains the process that a health care provider needs to follow to submit a transfer request of a Florida Medicaid MMA, Title XXI MediKids or long-term-care (LTC) member from his/her office to another provider’s office. Download the Provider-initiated Member Transfer Request Form (link opens in new window).
  • 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.

  • Important changes that will affect Humana Medicaid-covered patients (145 Kb) (link opens in new window) – This letter was distributed to general practice physicians to provide information about changes to Humana’s Healthy Behaviors programs and Humana members’ welcome kits.
  • Forms for pregnancy notification and C-section authorization:
  • Medicaid Eligibility for Newborn Babies (58Kb) (link opens in new window) – This communication was published by ACHA on April 17, 2015.
  • Second Quarter 2016 Updates for Physicians and Health Care Providers (428 Kb) (link opens in new window) – This publication provides updates for Humana Medicaid HMO network physicians and health care providers in Florida.

    Topics include:

    • NICU authorization process
    • IUD reimbursement
    • Humana’s Healthy Behavior programs
    • New Medicaid Provider Manual Appendix
    • AHCA oncology fee schedule updates
    • Member call campaigns
    • New call-hold messaging
    • 2016 compliance training requirements
  • Humana Updates for Physicians and Health Care Providers Archive (link opens in new window) – Find past editions of this publication for Humana Family Medicaid HMO network physicians and health care providers in Florida.
  • Healthy Behaviors – Effective Feb. 1, 2016, the following Healthy Behaviors programs are offered to MMA members:
    • Smoking cessation
    • Substance abuse
    • Humana Family Fit
    • Mom’s First
    • Baby well visits
    • Pediatric well visits
  • 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.

    Find useful information for primary care physicians regarding treating tobacco use and dependence from the Agency for Healthcare Research and Quality (link opens in new window).

Quality resources

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 (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 ebilling@americaneldercare.com.