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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 Kentucky Provider Documents and Resources

A female physician thinks deeply while reading information on her laptop

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

KY Medicaid Orientation and Training Module

Resource, reference, and billing guides

DentaQuest - Humana Healthy Horizons in Kentucky Medicaid Quick Reference Guide

EyeQuest - Humana Healthy Horizons in Kentucky Medicaid Quick Reference Guide

Humana Healthy Horizons in Kentucky Provider Resource Guide

Humana Healthy Horizons in Kentucky Policies Booklet

Provider relations representative assignments

Provider relations representative assignment list

Provider relations representative assignment map by county

Member Handbook

2025 Humana Healthy Horizons in Kentucky Member Handbook

2024 Humana Healthy Horizons in Kentucky Enrollee Handbook

Access our Find a Doctor service

Additional information

Behavioral health after-hours availability information

EviCore coverage policy updates

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 benefit claims processing and pharmacy prior authorization (PA) requests.

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 Humana Healthy Horizons® manages under our members’ medical benefits.

A list of preferred drugs covered under the KY PDL can be found on this page.

MedImpact manages all PA requests. To submit a PA request:

Call MedImpact at 844-336-2676

Fax 858-357-2612

Use the CoverMyMeds®, Surescripts®, or CenterX® ePA online portals

Kentucky Pharmacy and Therapeutics Committee

Kentucky Medicaid Maximum Quantity List

Pharmacy Quick Reference Guide

Preferred Drug List

Over-the-Counter Drug List

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

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

Physician Administered drug resources

Please submit all physician-administered and other medically billed drug PA requests to Humana Healthy Horizons. Medicaid providers may:

Obtain forms at Humana.com/medPA

Fax requests to 888-447-3430

View preauthorization and notification lists

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 this Sample coordination of care letter when providing behavioral health updates to primary care providers (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 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:

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 Humana.com/KentuckyVirtualCare.

*Internet access required

Availity Essentials™ 

Availity Essentials™ is a secure multi-payer portal that lets you interact with Humana Healthy Horizons and other participating payers without learning to use multiple systems or remembering separate payer usernames or passwords. Many Humana Healthy Horizons tools are accessible from the Humana Healthy Horizons payer space within Availity Essentials. Visit the Learn about Availity page for more information.

Availity Essentials™

How to register for the Availity portal

Other Resources

The following links provide additional guidance and information:

Accessing American Society of Addiction Medicine (ASAM) clinical criteria via InterQual Transparency

Kentucky Health Information Exchange (KHIE)

Cabinet for Health and Family Services (CHFS)

Department for Medicaid Services (DMS)

Credentialing verification

Provider documents and resources

Kentucky Medicaid