These documents and resources apply to all counties in Kentucky.

Access maternal health documents and resources

Provider manual

2025 Humana Healthy Horizons in Kentucky provider manual

Resource, reference, and billing guides

Humana Healthy Horizons in Kentucky Provider Resource Guide

Humana Healthy Horizons in Kentucky Policies Booklet

Enrollee Handbook

2025 Humana Healthy Horizons in Kentucky Member Handbook

2024 Humana Healthy Horizons in Kentucky Enrollee Handbook

Access our online Find a Doctor service

Additional information

Behavioral health after-hours availability information

Medicaid Prior Authorization and Notification List

Mental Health Resources for Teens and Young Adults English

Mental Health Resources for Teens and Young Adults Spanish

Non-discrimination, cultural competency, language proficiency, and Americans with Disabilities Act (ADA) information

Preauthorization for advanced imaging services

Primary care provider and specialist after-hours availability information

Evidence-based practice surveys

Evidence-based practice survey for non-group providers

Evidence-based practice survey for group/facility providers

Pharmacy resources

MedImpact is the pharmacy benefit manager (PBM) for all pharmacy claims processing and pharmacy prior authorizations (PAs).

All outpatient drugs, including over-the-counter drugs, are covered under a single Kentucky Preferred Drug List (PDL), also known as a formulary, managed by MedImpact. This does not include physician-administered drugs, which we continue to manage under our enrollees’ medical benefits.

View a list of preferred drugs covered under the KY PDL .

MedImpact manages all PAs. To submit a PA request:

• Call MedImpact at 844-336-2676
• Fax 858-357-2612
• Use the CoverMyMeds®, Surescripts®, or CenterX® ePA online portals

 

For all medically billed drug (J-code) PA requests, please continue to send those directly to us for review.

Please submit all claims with a date of service prior to July 1, 2021, to Humana Healthy Horizons® in Kentucky.

Please submit all claims with a date of service on and after July 1, 2021, to MedImpact.

Please use the  Kentucky Medicaid Pharmacy Prior Authorization Form  when submitting a PA request.

For pharmacy and therapeutics, go to  Pharmacy and therapeutics information  and select the “Committees” drop-down menu and then select “P&T.”

Kentucky Medicaid Maximum Quantity List

Kentucky Medicaid Single Preferred Drug List

Kentucky Medicaid Single PDL Prior Authorization Criteria

Pharmacy Quick Reference Guide

Preferred Drug List

Over-the-counter drug list

Forms

Primary Care Provider Change Request Form

External Independent Review (EIR) Request Form

Kentucky Physicians Certification Statement of Medical Necessity for Non-Emergency Ambulance Services

Contracted Rate Dispute Form

Hospice Consent Form

Incarceration Status Correction Form

Provider Appeal Form

Referral to Medicaid Case Management Form

Use the below sample coordination of care letter when providing behavioral health updates to PCPs.

Sample coordination of care letter

Diabetes management

Vida Health offers free personalized health coaching to our enrollees 18 or older who have type 2 diabetes and are not currently working with a Humana Care coach.

Through Vida Health, eligible enrollees can:

• Choose their own Vida Health coach (e.g., nutritionist, diabetes educator, etc.)
• Monitor their health progress
• Use video, phone or text to visit with their health coach
• View tips and videos customized to their health needs

 

Visit  Vida Health  to learn more. You also can call 855-910-1215 (TTY: 711) to refer a patient you believe could benefit from this program.

Kentucky Medicaid Diabetic Supplies Preferred Product List

Centers for Disease Control and Prevention (CDC) Hear Her campaign

The 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

HEDIS information

Access resources to help you meet Healthcare Effectiveness Data and Information Set (HEDIS®)* requirements.

Follow-up care for children prescribed attention-deficit/hyperactivity disorder (ADHD) medication (ADD)

Metabolic monitoring for children and adolescents on antipsychotics (APM)

Use of first-line psychosocial care for children and adolescents on antipsychotics (APP)

Follow-up after hospitalization for mental illness (FUH)

Follow-up after emergency department visit for mental illness (FUM)

Diabetes screening for people with schizophrenia or bipolar disorder who are using antipsychotic medications (SSD)

Cardiovascular monitoring for people with cardiovascular disease and schizophrenia (SMC)

Diabetes monitoring for people with diabetes and schizophrenia (SMD)

Antidepressant medication management (AMM)

Follow-up after emergency department visit for alcohol and other drug abuse or dependence (FUA)

Initiation and engagement of substance use disorder treatment (IET)

Pharmacotherapy for opioid use disorder (POD)

Follow-up after high-intensity care for substance use disorder (FUI)

Virtual care (telemedicine) services with MDLIVE

Our enrollees can connect with doctors 24 hours a day, 7 days a week via virtual visits with MDLIVE®. All MDLIVE doctors are state-licensed, board-certified experts attending patients virtually.

While enrollees can access this service, we reiterate that there are instances when they should receive in-person care from their PCP and/or a specialist, and when a visit to a retail clinic, urgent care center, or emergency room (ER) is needed.

MDLIVE provides consultation and treatment for a variety of healthcare needs, including cold and flu symptoms, medication adjustments, prescription refills, and skin conditions, without having to see anyone in person.

To get care via MDLIVE, our enrollees can:

1. Go to  MDLIVE *, create an account, and connect with a doctor
2. Call 844-403-0556 (TTY: 711), 24 hours a day, 7 days a week
3. Download* the MDLIVE mobile app from the App Store® or Google Play®

 

For more information about MDLIVE, please visit  Humana.com/KentuckyVirtualCare .

*Internet access required

Other resources

Availity Essentials® is a useful resource that allows healthcare providers to:

• Check the status of a claim
• File grievances and/or appeals
• Submit inquiries
• Submit supporting documentation

Availity

How to register for the Availity portal

The following links provide additional guidance and information:

Kentucky Health Information Exchange (KHIE)

Cabinet for Health and Family Services (CHFS)

Department for Medicaid Services (DMS)

Credentialing verification

Provider relations representative assignments

Provider relations representative assignment list

Provider relations representative assignment map by county