Through the Provider Advisory Council (PAC), Humana Healthy Horizons® in Ohio aims to gather input and to discuss and learn about issues affecting providers. It also serves as a forum to identify challenges, solve problems, share information and collectively find ways to strengthen the healthcare service delivery system. The PAC is one of many ways Humana Healthy Horizons plans to present new information and receive direct feedback from the provider network.

If you would like to join our PAC, email  OHMedicaidProviderRelations@Humana.com .

Upcoming council meeting

Thursday, March 20, 2025, 3 p.m. – 5 p.m.

Attention all Ohio Medicaid providers - Exciting changes to Ohio’s Medicaid program

Doula services

The Ohio Department of Medicaid (ODM) is pleased to offer doula services to its pregnant and postpartum members. As part of ODM’s commitment to improve the health of pregnant people, ODM and its Managed Care Organizations (MCOs) had offered doula services via pilot projects and through the Ohio Equity Institute (OEI) grants targeting communities with high rates of Black infant mortality. As of October 2024, any pregnant or postpartum person with Medicaid coverage can receive doula services from an Ohio Board of Nursing-certified, Medicaid-enrolled doula. If you are a doula, please refer to the Ohio Administrative Code (OAC) rules linked below for details about coverage and rates. 

Lactation consulting services

On Oct. 1, 2024, ODM increased coverage and payment for lactation consulting services. OAC rule 5160-8-42 to allow healthcare professionals who have obtained International Board Certified Lactation Consultant® certification to render and receive a separate professional payment. Payment amounts will be reflected on Appendix DD to the Medicaid payment rule 5160-1-60. The fee schedule can be found on The Register of Ohio website .

Nursing facility private room billing

As of Dec. 18, 2024, approved nursing facilities (NFs) can submit claims to receive incentive payments for Medicaid individuals receiving NF services in approved private room beds under fee-for-service Medicaid, Medicaid managed care or MyCare. NFs that applied for and were approved to receive the private room incentive payments have received an approval notice from ODM and been assigned a provider specialty that allows them to bill and be paid for Category 1 private rooms, Category 2 private rooms or both.

All NFs approved for the private room incentive payment have received private room billing guidance. Get details of private room billing guidance .

Portal submitted claims and all prior authorization requests

• All Next Generation plans will have portals for direct data entry. Providers should consult their  provider handbook  for instructions on how to bill using the portal.

The Next Generation managed care plans changes do not apply to MyCare Ohio plans, which will continue to provide benefits to Ohioans who receive Medicaid and Medicare benefits, with enhanced coordination of medical, behavioral, and long-term care services.

For additional information and resources visit the  Resources for Providers webpage of the Next Generation website

Help desks are available to assist providers.

• If you have questions about streamlined claims, prior authorization requests, administrative processes, ODM’s Provider Network Management module, OH|ID or portal password support, call the ODM Integrated Help Desk at 800-868-1516 or email  IHD@medicaid.ohio.gov .
• For billing and prior authorization guidance, call Humana Healthy Horizons at 877-856-5707, Monday – Friday, 7 a.m. – 8 p.m., Eastern time.

Need help?

Get information about who to contact depending on the help you need

Introducing Humana Healthy Horizons in Ohio

Humana Healthy Horizons has served Medicaid populations continuously for more than 2 decades and currently manages Medicaid benefits for nearly 800,000 members nationally. We developed expertise providing care management, care planning, and specialized clinical management for the complex needs of members within a social supports‐based framework.

We also developed significant expertise in integrating physical health, behavioral health, pharmacy and social services and supports for a whole-person centered approach to improving the health and well‐being of our members and the communities we serve.

In Ohio, Humana already serves 568,000 residents through Medicare Advantage, Medicare prescription drug plans, commercial employer-sponsored plans, commercial dental and vision coverage, and TRICARE.

All contracted providers are required to complete orientation and training. This training includes information about Humana and Humana Healthy Horizons in Ohio, covered services, expanded services, contracting and credentialing, access-to-care requirements, preauthorization and notification, and other key topics. We base these topics on our contract with ODM and on current Humana policies and procedures.

We hold virtual training sessions on the second Thursday of each month at 2 p.m., Eastern time, and on the fourth Tuesday of each month at 11:30 a.m., Eastern time.

Register for a Thursday training session .

Register for a Tuesday training session .

Join our network

By working closely with our providers, we can help our members in Ohio:

• Develop strong relationships with their primary care provider
• Get the right care in the right place at the right time
• Set and reach health goals

Once ODM completes implementation of its Next Generation Medicaid program, Humana Healthy Horizons in Ohio will administer care focused on Temporary Assistance for Needy Families, Expansion, and Assisted, Blind, and Disabled populations in the west, northeast, and central/southeast regions.

Submit your application and documentation

You can submit your enrollment application and supporting forms and documents Through Availity Essentials^®

1. Sign in to  Availity Essentials  (Register for an account if you don’t yet have one.)
2. Select “Payer Spaces” then “Humana” in the top header
3. Select the Applications tab in the middle of the page
4. Scroll down to select “Join our Network”, then follow the prompts to complete the form and submit your application. 

For additional information about joining our network:

Email:  OhioNetworkSpecialist@humana.com

Call: 877-856-5707, Monday – Friday, 7 a.m. – 8 p.m., Eastern time

Join our dental network

DentaQuest administers the Humana Healthy Horizons in Ohio dental plan. To join our dental network:

• Create an account in the Ohio Medicaid credentialing PNM module , and then
• Register with DentaQuest for Humana Healthy Horizons:
  
  • By using the  DentaQuest online provider portal , or
  • By calling the Humana DentaQuest provider phone line at 833-615-0432, Monday – Friday, 7 a.m. – 8 p.m., Eastern time

Existing DentaQuest providers who want to join the Humana Healthy Horizons in Ohio dental network can contact their DentaQuest representative for more information.

About Humana Healthy Horizons in Ohio

Nationally, we serve Medicaid members through:

• Medicaid Managed Care (MMC)
• Managed Long-term Services and Supports (MLTSS) programs
• Centers for Medicare & Medicaid Services (CMS) Financial Alignment Initiative Dual Demonstrations
• Medicare Advantage (MA)
• Dual Special Needs Plans (D-SNPs)
• Prescription drug plans (PDPs)

Humana Healthy Horizons in Ohio is a Medicaid Product of Humana Health Plan of Ohio, Inc.

Provider resources

We want to make working with us as easy as possible. Access key  documents and forms  for fast and efficient compensation. Access the  Humana Healthy Horizons in Ohio Provider Manual , learn about our  claims process , get  answers to frequently asked questions , and more.

See a sample network provider contract by provider type