Your Completion of Provider Compliance Training Materials is Important

The 2018 provider compliance materials are now available. CMS mandates that all physicians and health care professionals contracted for a Medicare product, including those contracted with a Humana subsidiary, attest to their understanding and adherence with compliance program requirements upon initial contract and at least annually thereafter. Humana is required to track completion.

The review and confirmation of these training materials is not meant to be a burden on you or your organization. Instead, they are meant to help physicians and health care professionals comply with government requirements and Humana's policies and procedures.

The requirements are outlined in the following materials:

  • Compliance Policy for Contracted Health Care Providers and Business Partners
  • Ethics Every Day for Contracted Health Care Providers and Business Partners (Standards of Conduct)
  • General Compliance training and Fraud, Waste and Abuse (FWA) training (via CMS-published content)
  • Special Needs Plans (SNP) training (if the organization has practitioners participating in any Humana Medicare HMO network in one of the following states or territories: Alabama, California, Colorado, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, Nevada, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Washington or Puerto Rico)
  • Medicaid-specific training (if the practitioner’s organization is supporting a Humana product for Medicaid or dual-eligible Medicare-Medicaid beneficiaries), which may include any or all of the following, depending on the state: Humana Orientation Training; Medicaid Provider Training; Health, Safety and Welfare Training; and Cultural Competency Training. For additional information, refer to the Illinois Duals page (https://www.humana.com/provider/support/clinical/medicaid-materials/illinois) and the Florida Medicaid page (https://www.humana.com/provider/support/clinical/medicaid-materials/florida).

While most compliance materials are retained from year to year, it is important to know that the materials may change. As clarifications are necessary or new requirements arise, Humana updates its documents.

To simplify your review of Humana materials, there is a “Notable Changes” section in the following documents:

  • Compliance Policy for Contracted Health Care Providers and Business Partners
  • Ethics Every Day for Contracted Health Care Providers and Business Partners

If you have questions, please call Humana Provider Relations at 1-800-626-2741 or email the partner compliance mailbox at partnercompliance@humana.com. More information also is available here.

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Kristine Bordenave, M.D., FACP, CPMA Corporate Medical Director