Virginia

Provider materials

Humana Gold Plus Integrated, VA Commonwealth Coordinated Care Plan

The document below highlights the key points related to Humana’s Virginia Demonstration 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 Virginia Demonstration program is about, what Humana needs from health care providers and what health care providers can expect from Humana.

Medicare-Medicaid preauthorization and notification list

The document below lists services and medications for which preauthorization may be required for Humana Gold Plus Integrated, A Commonwealth Coordinated Care Plan members in Virginia. Please review the detailed information at the top of the lists for exclusions and other important information before submitting a preauthorization request.

Jan. 26, 2015, Medicare and Dual Medicare-Medicaid Plans Preauthorization and Notification List – English (656 Kb)

Previous versions of the list can be found here.

Humana Gold Plus Integrated Prescription Drug Guide

Compliance requirements for health care providers

Humana and the state of Virginia 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)

Humana.com instructions

This document covers how to complete the required compliance requirements on Humana.com, how to register on Humana.com, how to create a new user, how to assign the compliance business function to another user and how to update an organization's tax identification number (TIN).

How to Complete the Training Requirements via Humana.com (97Kb)

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)

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).

Provider documentation

Details and documents related to provider training.

Long-term services and supports (LTSS) provider portal

Elderly or disabled with consumer direction (EDCD) waiver and custodial or intermediate-care nursing facility providers who need information regarding eligibility, authorizations and claims status can access the LTSS provider portal.