The Centers for Medicare & Medicaid Services (CMS) requires Medicare Advantage organizations to inform their network physicians and other healthcare professionals about the Medicare and Medicaid benefits and guidelines for patients who are eligible for both Medicare and Medicaid (i.e., dual eligibles).
An overview of the general eligibility and cost-sharing guidelines for Medicaid coverage of dual eligibles can be found here (link opens in new window).
Also, physicians and other healthcare professionals who participate in a Humana Medicare HMO network need to complete special needs plan (SNP) training if they are serving Humana-covered SNP patients in one or more of the following locations: Alabama, California, Colorado, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Maine, Missouri, Mississippi, Montana, Nebraska, Nevada, New York, North Carolina, Ohio, Pennsylvania, Puerto Rico, South Carolina, Tennessee, Texas, Virginia and Washington. The training outlines the responsibilities for physicians and other healthcare professionals related to their patients with Humana SNP coverage, as required by CMS.
CMS requires that the material outlined in the attestation form be reviewed and an attestation form be completed upon hire or contract and annually thereafter. For guidance or additional information about this requirement, please refer to Humana.com/providercompliance. For answers to other questions about compliance, please call Humana provider relations at 1-800-626-2741, Monday through Friday from 8 a.m. to 5 p.m. Central time.
The SNP training can be accessed at Humana.com/eod. Choose “View the 2018 SNP provider training.”