Health provider and patient in an exam room.

Access materials to help you serve Humana Healthy Horizons® in Ohio members, meet mandatory Ohio Medicaid provider training requirements and improve your experience working with Humana Healthy Horizons.

Provider orientation and training

You must complete the Medicaid compliance training if your organization has rendered or may render healthcare services for a Humana Healthy Horizons member.

  • Register for a live Provider Orientation and Training session (Tuesdays) .
  • Register for a live Provider Orientation and Training session (Thursdays) .

Review the Humana Healthy Horizons in Ohio Provider Orientation and Training module

Fraud, waste, and abuse

Contracted healthcare providers and third parties supporting Humana’s Medicare and/or Medicaid products must train their employees and those supporting them to meet certain contractual obligations to Humana. This includes:

  • Developing training on combating fraud, waste and abuse or using another training to meet that educational requirement
  • Tracking the training

Visit our Addressing fraud, waste and abuse page  for more information.


Compliance training

The following training modules must be completed annually by healthcare providers who participate in Humana Healthy Horizons in Ohio Medicaid plans. We recommend completing the following training modules via your secure Availity Essentials  account (registration required). After completing the training, you can submit the required attestation to receive credit for training completion.

Cultural competency training

This training module includes information about culture, cultural competence, clear communication, various subcultures and populations, strategies for working with seniors and people with disabilities, and additional information useful for serving your patients.

Cultural competency training

Health, safety, and welfare education training

This training module includes information about abuse; neglect; exploitation; interventions; “handle with care” measures; reporting abuse, neglect, or exploitation; rights of mandated reporters; general reporting requirements; critical incidents; and information about Ohio agencies.

View the Health, safety, and welfare education training module


Links to additional training materials

Availity Essentials orientation

Availity Essentials is a multipayer provider portal, so you need only one username and password to interact securely with Humana Healthy Horizons and other participating payers. This webinar provides an overview of how to use Availity Essentials to work with Humana Healthy Horizons online. Training topics include:

  • Checking eligibility and benefits
  • Submitting referrals and authorizations
  • Managing claims and payment information
  • Submitting requested medical records
  • Completing other secure administrative tasks online

Availity Essentials training

Doctor on Demand and telehealth

Telehealth services must be delivered in accordance with all state and federal laws, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Visit Humana's Ohio Medicaid: Understanding virtual care page .

Visit Humana's Telehealth services page .

Pregnancy Risk Assessment Form

Completion of the Pregnancy Risk Assessment Form (PRAF) is Ohio Medicaid’s preferred way for providers to notify the state and Humana Healthy Horizons of a member’s pregnancy. You can submit this information using a paper PRAF or online form.

  • Submit a completed PRAF 2.0 by visiting the Ohio Department of Medicaid (ODM)
  • Download and print the paper PRAF  . 
    • Instructions on how to complete the paper PRAF

Electronic visit verification

Electronic visit verification (EVV) involves using technology to document certain home health and personal care services provided in the home or community.

Visit ODM’s Presentations for Providers, Trade Associations and Stakeholders page.

Provider network management

As of Oct. 1, 2022, providers must utilize the Provider Network Management (PNM) module to access the Medicaid Information Technology System (MITS) portal. Providers can submit and adjust fee-for-service claims, submit prior authorization requests, submit hospice applications, and verify member eligibility. Providers also can submit cost reports for managed service providers, hospitals and long-term care.

Visit ODM’s Provider Network Management page for more information.

Early and Periodic Screening, Diagnosis and Treatment EPSDT

This module of the Providers Trainings & Education Sessions provides an overview of the federally mandated EPSDT program developed for Medicaid recipients under the age of 21.

Provider EPSDT Training

Assignment and Attribution

Both “assignment” and “attribution” refer to the association between members and providers, but the terms are not interchangeable. Humana Healthy Horizons in Ohio created this module to define these terms and describe the assignment and attribution process.

Assignment and Attribution training

“Find Help” or “Humana Community Navigator” or Community Resource Program

This module of the Providers Trainings & Education Sessions introduces the Humana Healthy Horizons in Ohio community resource program. You will hear about the ways this program addresses the gap between healthcare and community support services, review the ways that social determinants impact health, and the process for connecting your patients with the Find Help program.

Humana FindHelp Provider Training

Contracting

Humana Healthy Horizons in Ohio works with our healthcare providers to ensure the highest quality of care for our members, and we are committed to making it easy for you and your staff to do business with us. This module of the Providers Trainings & Education Sessions walks you through the process for becoming a new Humana Healthy Horizons in Ohio provider.

Training Coming Soon

Credentialling

Humana is committed to a seamless and expedient credentialing and re-credentialing process. In this module of the Provider Education Series, we will cover credentialing requirements, and best practices for submitting the required documentation to Humana.

Provider Credentialing Training

Provider Satisfaction Survey

Humana Healthy Horizons in Ohio annually surveys members and providers to measure health-plan performance. This module of the Provider Education Series provides an overview of the Provider Satisfaction Survey. Watch the video to learn about the survey and how Humana uses the results to improve performance and relationships with our providers.

Provider Satisfaction Survey Training

Private Duty Nursing/ PDN

Home health and private duty nursing (PDN) services benefits are included for all Humana Healthy Horizons® in Ohio members. Humana’s Utilization Management (UM) team reviews prior authorization requests for home health and PDN services. All prior authorization requests must be submitted through the Availity Essentials portal. UM decisions, including the length of time which services are authorized, are based on medical necessity and the member’s specific health needs.

Provider Home Health and PDN Training

Ohio Medicaid

  • Humana Healthy Horizons in Ohio
  • Answers to FAQs
  • Availity
  • Behavioral and physical health clinical coverage policies
  • Behavioral Health Tool Kit
  • Claims and payments
  • Clinical practice guidelines
  • Communications and network notices
  • Documents and resources
  • External medical review
  • Join our network
  • Optimization of pregnancy outcomes
  • Pharmacy
  • Pharmacy clinical coverage policies
  • Prior authorization
  • Provider network management
  • Services for children
  • Telehealth services
  • Training materials