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.
- Virginia Commonwealth Coordinated Care Appendix (310 KB) – Effective May 15, 2015
- Virginia Commonwealth Coordinated Care Appendix (289 KB) – Effective February 2014
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.
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