These documents apply to all parishes where Humana Healthy Horizons coverage is available.

Louisiana Crisis Services

Humana Healthy Horizons in Louisiana Provider Manual, effective August 1, 2025

Humana Healthy Horizons in Louisiana Provider Manual, effective Oct. 1, 2025

Outpatient Lactation Support - Provider Training for Billing and Claims Payment

Pediatric Day Healthcare (PDHC)-Prior Authorization Checklist

Standing Frame Evaluation

Drug withdrawal notice for Oxbryta

Humana Healthy Horizons in Louisiana OB-GYN Provider Resource Guide

Electric Breast Pump Request Form

2024 Behavioral Health Provider Quality Monitoring Training Flyer-Yearly Calendar

Louisiana Medicaid Managed Care Organization (MCO) Manual Update effective October 18, 2023

Attached is the Clinical Trial form. Please complete and return with any prior auth request for care related to a clinical trial

LDH Directed Payment Incentive Program Guidance Document (PowerPoint)

Directed Payment Incentive Program Invoice form (Excel)

American Rescue Plan Act (APRA) Training Questions

2025 Humana Healthy Horizons in Louisiana Provider Resource Guide

Doula Services Claims and Payment Billing Guide

Access a searchable provider directory via our online Find a Doctor service

Evidence-based practice form

Care management referral form

2025 Humana Healthy Horizons in Louisiana Member Handbook – English

2025 Humana Healthy Horizons in Louisiana Member Handbook – Spanish

2024 Humana Healthy Horizons in Louisiana Member Handbook – English

2024 Humana Healthy Horizons in Louisiana Member Handbook – Spanish

Addressing Social Determinants of Health (SDOH) Physician Quick Guide

Independent review reconsideration form

Claim reconsideration and appeal form

Accessing behavioral health specialists for primary care physician consultations

Notification of pregnancy form

Clinical practice guidelines

Humana has in place clinical practice guidelines for Humana-participating physicians and other Humana-contracted healthcare professionals. Humana periodically monitors compliance with nationally recognized clinical practice guidelines.

Review Humana’s clinical practice guidelines

Behavioral health clinical practice guidelines

Behavioral health guidelines are evidence-based treatment options for common behavioral health conditions. Derived from credible sources and reviewed semiannually by Humana psychiatrists who support the treatment options, these guidelines are a means to standardize treatment with the most effective interventions available.

Review Humana’s behavioral health guidelines

Behavioral health documents and forms

These documents apply to all parishes where Humana Healthy Horizons coverage is available.

Behavioral Health Concurrent Review for Inpatient and Partial Hospitalization Program

Behavioral Health Initial Review for Inpatient and Partial Hospitalization Program

Behavioral Health Individual Placement and Support Request Form

Behavioral Health Community Based Outpatient Services Request Form

Behavioral Health Neuropsychological Testing Request Form

Behavioral Health Personal Care Services Request Form

Behavioral Health Peer Support Request Form

Behavioral Health Rehabilitation Request Form

Behavioral Health Crisis Services Treatment Request Form

Behavioral Health Applied Behavioral Health Authorization

Behavioral Health Psychiatric Residential Treatment Facility (PRTF) Prescreening Request Form

Behavioral Health Psychological Testing Authorization Form

Community Psychiatric Support and Treatment (CPST) and Psychosocial Rehabilitation (PSR) Outpatient Treatment Request (OTR)

Chronic care management monitoring tool elements

The Chronic Care Management (CCM) Quality Monitoring Plan is designed to comply with the requirements specified in the Department of Justice Agreement Compliance Guide (DOJ Compliance Guide) for a monitoring plan and strategy of CCM Agencies to ensure delivery of effective CCM services program requirements are satisfactorily met. As required by the DOJ Compliance Guide and related LDH directives, our plan includes all requirements as specified by LDH.

Review CCM monitoring tool elements

Provider network monitoring

Provider Network Management Quality Review Tool Elements – Assertive Community Treatment (ACT)

Provider Network Management Quality Review Tool Elements – Adolescent/Child Crisis Stabilization (CS)

Provider Network Management Quality Review Tool Elements – Adult Crisis Provider Agency Requirements

Provider Network Management Quality Review Tool Elements – Adult Crisis Response Services

Provider Network Management Quality Review Tool Elements – Functional Family Therapy (FFT/FFT-CW)

Provider Network Management Quality Review Tool Elements – FQHC and RHC Agency Requirements

Provider Network Management Quality Review Tool Elements – HomeBuilders (HB)

Provider Network Management Quality Review Tool Elements – Individual Outpatient Provider

Provider Network Management Quality Review Tool Elements – MHR/CPST/PSR/CI

Provider Network Management Quality Review Tool Elements – MultiSystemic Therapy (MST)

Provider Network Management Quality Review Tool Elements – Opioid Treatment Program (OTP)

Provider Network Management Quality Review Tool Elements – Outpatient Agency Requirements

Provider Network Management Quality Review Tool Elements – Personal Care Services

Provider Network Management Quality Review Tool Elements – Peer Support Service Agency Requirements

Provider Network Management Quality Review Tool Elements – PRTF Agency Requirements

Provider Network Management Quality Review Tool Elements – SUD Core Requirements

Provider Network Management Quality Review Tool Elements – TGH Agency Requirements

Provider Network Management Quality Review Tool Elements – Youth Crisis Response

Physical health documents and forms

These documents apply to all parishes where Humana Healthy Horizons coverage is available.

Physical Health Authorization Request Form

Physical Health Outpatient Therapy Authorization Request Form

Request for Medicaid EPSDT – Personal Care Services

Request for Prior Authorization – EPSDT Personal Care Services

EPSDT Personal Care Services – Social Assessment Form

EPSDT Personal Care Services – Daily Schedule

EPSDT Personal Care Services – Plan of Care

Care Coordination Portal (population health module)

The Care Coordination Portal allow providers to monitor clinical measures and care coordination completed for members assigned to their panel. Access this portal by: 

• Signing in to Availity
• Navigating to the Humana Healthy Horizons in Louisiana Payer Spaces section
• Selecting Resources

The Louisiana Medicaid Care Management link will direct providers to the population health dashboard. This allows providers to view member assessments, care plans, authorizations, assigned care management programs, and contact information for the member’s care manager.

Pharmacy resources

Over-the-counter value-added benefit catalog and order form – English

Over-the-counter value-added benefit catalog and order form – Spanish

Preferred drug list

Pharmacy benefits manager

Pharmacy benefits management services manual

Pharmacy locator

Adverse incident reporting

After learning of an adverse incident that affects one of your patients, providers are required to complete and submit the Managed Care Organization (MCO) Adverse Incident Reporting form to the patient’s Louisiana Medicaid MCO—not to the state. You must complete and submit the form within 24 hours of learning about the adverse incident. For patients with coverage through Humana Healthy Horizons in Louisiana, please fax this form to us at 1-888-305-7974.

MCO Adverse Incident Reporting form