illinois

Provider materials

Humana Integrated Care Program of Illinois and Humana Gold Plus Integrated (Medicare-Medicaid)

Humana Exiting Illinois’ Medicaid Integrated Care Program Effective Jan. 1, 2018.

Humana will not be a part of the Medicaid Integrated Care Program (ICP) as of Jan. 1, 2018; however, there will be other plans providing health benefits to Medicaid members under Illinois’ new Medicaid program. Humana will continue to provide Medicare-Medicaid Alignment Initiative (MMAI) plans for dual-eligible members in Illinois through 2018.

If your patients currently receive Medicaid benefits through Humana, they do not need to do anything until they hear from the state. Members with questions may call the number on the back of their ID card.

Health care professionals with questions about this transition are encouraged to contact their local provider representative.

Illinois joint CMS-State sponsored Medicare Medicaid Alignment Initiative ("Demonstration") and Illinois Integrated Care Program (ICP) Appendix

The document below highlights the key points related to Humana Demonstration and ICP policies and procedures and is an extension of participating health care providers' contracts. It is intended to be a guideline to facilitate and inform health care providers on what the Illinois Demonstration and ICP is about, what Humana needs from health care providers and what health care providers can expect from Humana.

Illinois joint CMS-State sponsored Medicare Medicaid Alignment Initiative ("Demonstration") and Illinois Integrated Care Program (ICP) Appendix - English (743 Kb) – effective Sept. 1, 2016

Illinois joint CMS-State sponsored Medicare Medicaid Alignment Initiative ("Demonstration") and Illinois Integrated Care Program (ICP) Appendix - English (381 Kb) – effective March 2014

Illinois joint CMS-State sponsored Medicare-Medicaid Alignment Initiative (MMAI) and Illinois Integrated Care Program (ICP) Appendix Bulletins

Medical Transportation Management provides nonurgent medical transportation for patients with Humana Integrated Care Program (ICP) of Illinois (Medicaid) and Humana Gold Plus Integrated (MMAI) coverage (195 Kb) (link opens in new window) – Effective July 1, 2017

Humana supports physicians and clinicians to ensure safe opioid utilization (198 Kb) (link opens in new window) – Effective July 1, 2017

Humana Integrated Care Program of Illinois preauthorization and notification list

The document below lists services and medications for which preauthorization may be required for Humana Integrated Care Program of Illinois members. Please review the detailed information at the top of the lists for exclusions and other important information before submitting a preauthorization request.

Jan. 23, 2017 Medicaid Preauthorization and Notification List – English (493 Kb)

Jan. 18, 2016, Medicaid Preauthorization and Notification List – English (476 Kb)

Previous versions of the list can be found here.

Humana Gold Plus Integrated (Medicare-Medicaid) preauthorization and notification list

The document below lists services and medications for which preauthorization may be required for Humana Gold Plus Integrated (Medicare-Medicaid) members. Please review the detailed information at the top of the lists for exclusions and other important information before submitting a preauthorization request.

Jan. 22, 2018, Medicare and Dual Medicare-Medicaid Plans Preauthorization and Notification List – English (726 Kb)

Jan. 23, 2017, Medicare and Dual Medicare-Medicaid Plans Preauthorization and Notification List – English (726 Kb)

Previous versions of the list can be found here.

Humana Integrated Care Program of Illinois Prescription Drug Guide

Humana Gold Plus Integrated (Medicare-Medicaid) Prescription Drug Guide

Cultural Competency Program Information

Compliance requirements for health care providers

Humana and the state of Illinois require that all entities that participate with dual Medicare-Medicaid plans and Medicaid plans, including those contracted with subsidiaries, complete the following training materials:

  • Cultural Competency Training
  • Health, Safety and Welfare Education Training
  • Medicaid Provider Training
  • Humana Orientation Training
  • Compliance and Fraud, Waste and Abuse Training

The information below is provided to help you complete these requirements:

Frequently asked questions and answers

This document provides additional information regarding the compliance requirements and Web access.

Compliance Requirements for Health Care Providers – Frequently Asked Questions and Answers (302Kb) (opens in new window)

Availity.com instructions

This document covers how to complete the compliance requirements on Availity.com, how to register on Availity.com, how to create a new user, how to assign the compliance business function to another user and how to update an organization's TIN.

How to Complete the Training Requirements via Availity.com (120Kb) (opens in new window)

If your organization is unable to register on Humana.com or Availity.com (link opens in new window) , refer to the following document:

Training Requirements for Health Care Providers Who Are Unable to Register (193Kb) (opens in new window)

Medicaid Hospice Benefit Election

The Illinois Department of Healthcare and Family Services (HFS) requires the submission of the Medicaid hospice benefit election standardized form to HFS for patients with Medicaid and dual Medicare-Medicaid coverage who elect hospice care. Hospice providers must complete the form for each hospice patient. (Please see the notice posted here: http://www.hfs.illinois.gov/assets/040714n.pdf (link opens in new window) .)

A copy of the Hospice Benefit Election Form can be found here:

https://www.illinois.gov/hfs/SiteCollectionDocuments/hfs1592.pdf (link opens in new window) .

This form must also be submitted to HFS when a patient dies, ceases hospice care or transfers to another hospice. Effective May 1, 2014, use of this form is mandatory. Hospices are asked to allow two weeks after submittal of the HFS 1592 before submitting a claim.

If a patient is covered under a managed care entity (MCE) contracted with HFS, hospice providers must also submit a copy of the HFS 1592 form to the MCE.

For patients with Humana Integrated Care Program of Illinois (Medicaid) or Humana Gold Plus Integrated (Medicare-Medicaid) coverage via Humana, submit a copy of the HFS 1592 form to Humana using one of the following methods:

Questions regarding this notice should be directed to the hospice’s billing consultant in the Bureau of Comprehensive Health Services at 1-877-782-5565.

Long-term services and supports (LTSS) provider portal

Long-term services and supports (LTSS) providers who need information regarding eligibility, authorizations and claims status can access the LTSS provider portal (opens in new window).