Provider documents and resources
These documents and resources apply to all counties in Kentucky.
Provider manual
Resource, reference, and billing guides
Enrollee Handbook
Additional information
Evidence-based practice surveys
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.
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
For pharmacy and therapeutics, go to
Forms
Use the below sample coordination of care letter when providing behavioral health updates to PCPs.
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
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.
HEDIS information
Access resources to help you meet Healthcare Effectiveness Data and Information Set (HEDIS®)* requirements.
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:
- Go to
MDLIVE *, create an account, and connect with a doctor - Call 844-403-0556 (TTY: 711), 24 hours a day, 7 days a week
- Download* the MDLIVE mobile app from the App Store® or Google Play®
For more information about MDLIVE, please visit
*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
The following links provide additional guidance and information:
Provider relations representative assignments