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Join our network and find credentialing information.

Log in to Availity Essentials™ to access patient benefits, claims information and more.

Find tools and materials to support doing business with us.

Learn more about research and trends that impact your practice.

Find self-service info and phone numbers and update your provider data.

Review prior authorization lists for services, medications and submission guidance.

Prior authorization submission information

Professionally administered drugs prior authorization

Find appeals guidelines and payment policy information.

Learn how to submit claims and find coding guidance.

Find policies for procedures, devices and medications.

Review guidelines and health programs to support your patients and practice.

Find dental benefits, tools and resources.

Prior authorization for professionally administered drugs 

Locate state-specific resources for Humana Healthy Horizons® (Medicaid).

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Search for in-network medical, vision, dental and pharmacy providers.

Independent Care Manager Information Form

ContractorAddress.FirstName

ContractorAddress.MiddleName

ContractorAddress.LastName

ContractorAddress.StreetOne

ContractorAddress.StreetTwo

ContractorAddress.City

ContractorAddress.State

ContractorAddress.Zipcode

IsDifferentAddress

ContractorNewAddress.FirstName

ContractorNewAddress.MiddleName

ContractorNewAddress.LastName

ContractorNewAddress.StreetOne

ContractorNewAddress.StreetTwo

ContractorNewAddress.City

ContractorNewAddress.State

ContractorNewAddress.Zipcode

ContractorDOB

ContractorEmail

ContractorPrimaryPhone

ContractorBusinessPhone

ContractorMobilePhone

ContractorFax

ContractorDriverLicense

ContractorDriverLicenseStateIssued

ContractorDriverLicenseExpirationDate

ContractorEmploymentStatus

GeographiesList[0].StateServed

GeographiesList[0].CountyServed

GeographiesList[0].Distance

GeographiesList[0].ServicesProvided

GeographiesList[0].Comments

AddNewState

GeographiesList[1].StateServed

GeographiesList[1].CountyServed

GeographiesList[1].Distance

GeographiesList[1].ServicesProvided

HaveWorkHistory

CompanyNames

PrimaryLanguage

LanguagesSpoken

AdditionalLanguages

OtherLanguagesSpoken

BusinessName

BusinessFax

BusinessPhone

BusinessLegalStatus

OtherLegalStatus

HaveBusinessLicense

BusinessLicenseList[0].LicenseNumber

BusinessLicenseList[0].State

BusinessLicenseList[0].ExpirationDate

BusinessLicenseList[0].MultiState

BusinessLicenseList[0].AddAnotherLicense

Specializations

HaveDegree

DegreeList[0].DegreeType

DegreeList[0].Institution

DegreeList[0].DateOfDegreeReceived

DegreeList[0].AddAnotherDegree

HaveLicence

LicenseList[0].LicenseNumber

LicenseList[0].LicenseType

LicenseList[0].State

LicenseList[0].ExpirationDate

LicenseList[0].Comments

LicenseList[0].MultiState

LicenseList[0].AddAnotherLicense

HaveCertification

CertificationList[0].CertificationType

CertificationList[0].ReceivedDate

CertificationList[0].ExpirationDate

CertificationList[0].IssuingOrganization

CertificationList[0].AddAnotherCertification

CertificationList[1].CertificationType

CertificationList[1].ReceivedDate

CertificationList[1].ExpirationDate

CertificationList[1].IssuingOrganization

ResumeAttachment

ExhibitAAttachment

LicenseAttachment

HeadshotPhotoAttachment

InsuranceAttachment

SecurityAgreementAttachment

W9Attachment

OwnershipDisclosureAttachment

LetterOfAgreementAttachment

HIPPAAttachment

CareManagementCertificateAttachment

GeneralLiabilityAttachment

HomeQualificationAttachment

BusinessLicenseAttachment

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