2024 Provider Manual

Provider Network Resource Guide

Physical and Behavioral Health Provider Representative Map

Provider resource guide: 24-hour availability requirements

Rights and responsibilities – English 

HIPAA privacy notice – English

Long-Term Services and Supports/Home and Community-Based Services County Breakdown by Region

Long-Term Services and Supports/Home and Community-Based Services Provider Representatives Map

Learn what drugs are approved to prescribe to PathWays members.

Preferred Drug List (English)

Preferred Drug List (Spanish)

Indiana Medicaid Statewide Uniform Preferred Drug List (SUPDL)

Antiviral Monoclonal Antibodies Form

Benzo-Opioid Duplicate Therapy PA Form

Bone Formation Stimulating Agents PA Form

Buprenorphine-Opioid Concurrent PA Form

Cardiac Agents PA Form

Carisoprodol PA Form

Dificid PA Form

Growth Hormone Adult PA Form

Growth Hormone Children PA Form

Hetlioz PA Form

Narcolepsy Agents PA Form

Opioid MME Limit Exceed PA Form

PCSK9 and Select Lipotropics PA Form

Pulmonary Antihypertensives PA Form

Testosterones PA Form

Uterine Disorder Agents PA Form

Vaginal Antimicrobials PA Form

The Centers for Medicare & Medicaid Services (CMS) and state Medicaid contracts mandate that all Humana-contracted healthcare providers complete compliance program requirements each year.

Healthcare providers must complete annual compliance training requirements by Dec. 31 each year on the following topics:

• Cultural humility and implicit bias training
• Health, safety and welfare training
• New provider orientation

We recommend completing the compliance training via your secure Availity Essentials account (registration required). After completing the training, an attestation of completion must be submitted through Availity Essentials™.

As a provider in the Humana Healthy Horizons network, you also have access to Relias. Relias is a library of continuing education materials about a variety of health topics that will help you better serve our PathWays members.

How to access Relias

Use the Healthcare Provider Training Calendar to schedule virtual training sessions.

The below is intended to provide general guidance to providers when submitting drug claims under Section 340B of the Public Health Service Act. Providers should refer to provider resource materials (e.g., Indiana Health Coverage Programs provider reference modules, Humana Healthy Horizons provider manuals, etc.) for specific instructions and requirements. Humana Healthy Horizons requires the use of modifiers on all claims. Pharmacies may be required to complete a contract addendum with Humana Healthy Horizons to be eligible to dispense 340B medications under their agreement with Humana Healthy Horizons.

For pharmacy claims (National Council for Prescription Drug Programs [NCPDP]):

• 340B status: NCPDP field number 420-DK, submission clarification code of 20 for pharmacy claims. This code indicates that the product on the claim was dispensed from 340B stock.
• 340B pricing NCPDP field number 423-DN, basis of cost determination code of 08 for pharmacy claims. This code indicates that the acquisition cost of the claim is based on 340B pricing

For provider-administered claims (CMS-1500 or UB-04):

• TB – Separately payable Part B drugs and biologicals acquired with 340B drug pricing program discount, reported for informational purposes

For pharmacies seeking additional questions regarding 340B policy, please contact the pharmacy help desk at 855-816-6461 or see the Humana Pharmacy Provider Manual for additional details on 340B requirements.

For providers seeking additional questions regarding 340B policy, please contact Provider Services at 866-274-5888 (TTY: 711) or see the Humana Healthy Horizons Provider Manual for additional details on 340B requirements.