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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.

Illinois Medicare-Medicaid Provider Documents

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Illinois joint CMS-State sponsored Medicare-Medicaid Alignment Initiative (MMAI)

MMAI Provider Resource Guide

2024 Illinois-CMS-sponsored MMAI (Demonstration) provider manual – effective October 1, 2024

2022 Illinois-CMS-sponsored MMAI (Demonstration) provider manual – effective October 10, 2022

Treating COVID-19

The Illinois Dept. of Health (IDH) continues to encourage providers to assess patients quickly of the onset of COVID-19 symptoms to determine if they are eligible for one of four available treatments. The IDH asks providers to refer to the NIH Clinical Decision Aid

The National Institutes of Health (NIH) COVID-19 Treatment Guidelines recommends ritonavir-boosted nirmatrelvir (Paxlovid), as the preferred treatment for most high-risk, non-hospitalized patients with mild to moderate COVID-19.

Paxlovid Checklist Tool for Prescribers

You can send prescriptions to federal pharmacy partners and community pharmacies, all of which are listed in the COVID-19 Therapeutic Locator.

The IDH provided the following resources for providers:

COVID-19 Therapeutic Locator

COVID-19 treatment guidelines

IDPH Outpatient Therapy locator (to find doses of COVID-19 treatment in your area)

IDPH Therapy Matchmaker (when you only need to find a small number of doses)

Submit all therapeutics orders in the HPoP. Existing providers need to access their account and “Create order.” New therapeutics providers can submit a registration request through the New Provider Site Registration Form

If you have questions:

Email dph.mabtherapy@illinois.gov

Call 800-889-3931



Humana Gold Plus® Integrated Medicare-Medicaid plan prior authorization and notification lists

The document below lists services and medications for which preauthorization may be required for Humana Gold Plus Integrated (Medicare-Medicaid) members. Please review the detailed information atop each list regarding exclusions and other important information before submitting a preauthorization request.

Jan. 1, 2024, Medicare and Dual Medicare-Medicaid Plans Prior Authorization and Notification List – English

You can also download previous versions of the prior authorization and notification list.

Humana claim-payment inquiry resolution guide

To simplify claim payment inquiries, Humana has worked to clarify its process and to ensure that you have the support you need. Refer to the below document to learn more.

Humana claim-payment inquiry resolution guide

Humana Gold Plus Integrated (Medicare-Medicaid) Pharmacy Materials

2024 Prescription Drug Guide – English

2024 Prescription Drug Guide – Spanish

2023 Prescription Drug Guide – English

2023 Prescription Drug Guide – Spanish

2022 Prescription Drug Guide – English

2022 Prescription Drug Guide – Spanish

Learn more about our process for reviewing and giving prior authorization and our step-therapy criteria.

2024 Illinois Prior Authorization Criteria

2024 Illinois Step-Therapy Criteria

2023 Illinois Prior Authorization Criteria

2023 Illinois Step-Therapy Criteria

2022 Illinois Prior Authorization Criteria

2022 Illinois Step-Therapy Criteria



Health & Wellness Order Form – English

Health & Wellness Order Form – Spanish

Centers for Disease Control and Prevention HEAR HER campaign

The Centers for Disease Control and Prevention (CDC) launched recently an initiative called HEAR HER, which includes information, stories, and resources for providers with pregnant patients in their panel. Learn how preventing maternal deaths and complications starts with listening.

CDC HEAR HER campaign

Stakeholder Advisory Committee

We invite community partners and stakeholders to join a quarterly virtual Stakeholder Advisory Committee. During our meetings, we encourage participants to:

Provide feedback on how we’re doing as a health plan

Share insights into how we can better serve our members



Enroll in our Stakeholder Advisory Committee

Medicaid Hospice Benefit Election

The Illinois Department of Healthcare and Family Services (HFS) requires the submission of the Medicaid Hospice Benefit Election Standardized Form to HFS for patients with Medicaid and dual Medicare-Medicaid coverage who elect hospice care. Hospice providers must complete the form for each hospice patient. Please see this notice.

Hospice Benefit Election Form

This form also must be submitted to HFS when a patient dies, ceases hospice care or transfers to another hospice. Use of this form is mandatory. Hospices are asked to allow two weeks after submittal of the HFS 1592 before submitting a claim.

Please visit Illinois government’s forms and documents page for other Illinois Medicaid forms.

If a patient is covered under an HFS-contracted managed care entity (MCE), hospice providers also must submit a copy of the HFS 1592 form to the MCE.

For patients with Humana Gold Plus Integrated coverage via Humana, please submit a copy of the HFS 1592 form to Humana using one of the following methods:

Email: HumLTSSTransitions@humana.com

Questions regarding this notice should be directed to the hospice’s billing consultant in the Bureau of Comprehensive Health Services at 877-782-5565.

Provider Authorization Statistics

Provider Authorization Statistics

Illinois Medicaid Provider Notices and Updates

Illinois Medicaid Provider Training Materials

Illinois Medicaid Provider Long-Term Services & Support

Provider documents

Illinois Medicaid