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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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Shop plans, learn about Medicare and explore member resources.

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

Humana Healthy Horizons in Florida MMA provider education materials

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We include below important information we want our providers to have. Check back often, as we update materials periodically during the year. 

2023 Humana Healthy Horizons in Florida Provider Manual - effective October 1, 2023

2022 Humana Healthy Horizons in Florida Provider Manual – effective March 3, 2022

Refer to the Humana Healthy Horizons Provider Resource Guide for information about resources we make available to providers.

Humana Healthy Horizons in Florida Provider Resource Guide

Refer to the Humana Healthy Horizons in Florida Resource Guide for a list of departments and personnel that can assist with the coordination and authorization of services a patient in your panel with Humana Healthy Horizons coverage may need.

Humana Healthy Horizons in Florida Resource Guide

Claims processing updates for taxonomy and National Provider Identifier (NPI) requirements

The Agency for Health Care Administration (AHCA) released guidance about updates to the Provider Master List (PML) effective for dates of service starting March 1, 2022. Humana Healthy Horizons processes claims in accordance with this logic/guidance, generating denials when the appropriate taxonomy, ZIP code, or address information are not billed for providers with multiple active Medicaid IDs and specialties. We want to partner with you to assist in preventing future denials. 

Claims processing updates for taxonomy and NPI requirements

Learn how to submit an American Rescue Plan Act (ARPA) Home- and Community-Based Services (HCBS) payment request

Humana Billing Rules for Medicaid, NPI, Taxonomy and Address Validation for Claims

Humana Healthy Horizons in Florida ARPA HCBS payment request information

Humana Healthy Horizons in Florida expanded benefits

Electronic visit verification (EVV) claims submission requirements - effective June 21, 2021

Expanded benefit – hepatitis A vaccine for adults coverage information

Humana Healthy Horizons in Florida Member Handbook

Access to care requirements for Humana Healthy Horizons in Florida members

For Pediatric Therapy access-to-care issues or complaints, please contact:

Theresa Bell
Humana - Senior Process Improvement Professional
Phone: 502-354-1364
Email: FLMedicaidResolution@humana.com

When one of your patients moves out of your service area

Please notify Humana Healthy Horizons if you become aware that one of your patients with Humana Healthy Horizons in Florida coverage moves out of your service area. Please complete this notification form and send back by fax or email. 

Humana Healthy Horizons in Florida network-contracted healthcare providers should use the Notification of Deceased Member Form to notify us when a member dies.Notification for Deceased Member Form

Health and dental plans are required to ensure continuity of care during the transition period for SMMC-enrolled Medicaid recipients. COC requirements ensure that members transfer without service lapse between health plans, service providers and service delivery systems (i.e., fee-for-service to managed care).

AHCA has instituted the following COC provisions:

    Healthcare providers should not cancel appointments with current patient

    For 60 days after the rollout date in each region, health plans must honor any ongoing treatment authorized prior to the recipient’s enrollment into that plan


Continuity of care provisions program highlights

Continuity of care information – SMMC plan website links

MMA Physician Incentive Program (MPIP) education materials

Humana MPIP Year 8 Plan Program Summary

Humana MPIP Year 7 Plan Program Summary

Humana MPIP Year 6 Plan Program Summary

Humana MPIP Year 5 Plan Program Summary

Humana MPIP Year 4 Plan Program Summary

Case management education materials and forms

Available Humana Healthy Horizons in Florida clinical programs

Controlling and managing sickle cell disease

Humana Healthy Horizons in Florida case management recommendations for Asthma

Humana Healthy Horizons in Florida Case Management recommendations for chronic obstructive pulmonary disease (COPD)

Humana Healthy Horizons in Florida Case Management recommendations for heart failure

Humana Healthy Horizons in Florida Case Management recommendations for diabetes

Referral to Medicaid Case Management Form (all regions)

Medicaid Preauthorization and Notification List (PALs)

Except where noted, prior authorization requests for medical services may be initiated:

Online via Availity (registration required)

By calling Humana’s interactive voice response (IVR) line 24-hours a day at 800-523-0023 (Humana Customer Care representatives are available Monday - Friday, 8 a.m. - 8 p.m. Eastern time)



NOTE: Online prior authorization requests are encouraged. Additionally, clinical information for a medical service preauthorization request may be faxed to 813-321-7220.

Except where noted, prior authorization requests for medications billed as medical claims may be initiated:

By sending a fax to 888-447-3430 (request forms are available at Humana.com/medpa

By calling 866-461-7273 (available Monday - Friday, 8 a.m. - 6 p.m. Eastern time)



Except where noted, prior authorization requests for durable medical equipment (DME) may be initiated:

For regions 1–8: By calling 866-856-8974, the Humana clinical intake team, (available Monday - Friday, 8 a.m. - 5 p.m. Eastern time)

For regions 9–11: By sending a fax to 855-441-6941 (One Homecare Solutions) or calling 855-441-6900 (available Monday - Friday, 8:30 a.m. - 9 p.m., and Saturday and Sunday, 9 a.m. to 5 p.m. Eastern time)



When asking us to authorize outpatient therapy, please complete and attach our Outpatient Therapy Authorization Request Form to your clinical documentation and signed plan of care.

Outpatient Therapy Authorization Request Form

Provider documents

Notification of Deceased Member Form

Statewide Medicaid managed care (SMMC): Continuity of care (COC) provisions

How to request other prior authorization

Outpatient therapy authorization

Florida Medicaid