Effective June 13th, 2025, providers contracted only with Humana Medicare Products who join non-delegated participating groups will have a network effective date that is thirty calendar days after all required documentation is received. Members who are seen prior to the network effective date generally will have claims paid at an out-of-network level. Please contact your local market representative with any questions.
Credentialing is the process of obtaining and reviewing documentation to determine participation status in a health plan. The documentation may include, but is not limited to, the applicant’s education, training, clinical privileges, experience, licensure, accreditation, certifications, professional liability insurance, malpractice history and professional competence. Generally, the terms credentialing and recredentialing include the review of the information and documentation collected, as well as verification the information is accurate and complete.
Please note:
- Facilities and organizational providers that are already contracted with Humana but need to be credentialed should download our
organizational provider credentialing , application and fax it to 1-502-508-0521 or email it tocredentialinginquiries@humana.com . - Puerto Rico healthcare professionals interested in credentialing should send an email to
PRCredentials@humana.com or call 1-877-384-5037. The information below does not apply to Puerto Rico. -
View the credentialing and recredentialing policies here . - For answers to questions about credentialing status or the process described below, please call 1-800-626-2741 and choose the option that says, “Have a question about a contract?”
Important credentialing update for WI, CO, and MA
Humana is entering into a multi-payer credentialing solution in partnership with Elevance and Sutherland Healthcare Solutions. This initiative aims to streamline the recredentialing process, enhance efficiency and reduce administrative burdens for our providers.
Pilot regions: This program will initially launch as a pilot in Wisconsin, Colorado and Massachusetts.
Action required: Please ensure your CAQH profiles are up-to-date and authorized for information sharing across plans. Your earliest recredentialing date will determine the start of this consolidated process. Once your recredentialing is complete, your file will be shared with all affiliated health plans, standardizing your recredentialing date across these organizations.
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Join our network Credentialing CAQH - Credentialing for facilities and organizations
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