stethoscope

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.

Optimization of pregnancy outcomes

A male doctor takes notes on a patient's chart

The Ohio Perinatal Quality Collaborative (OPQC) Progesterone Project's goal is to decrease premature births in Ohio before 32 weeks by 10%, by:

Identifying women with increased risk early in pregnancy

Starting treatment with progesterone

Learn more about the Prematurity Prevention (Progesterone) Project.

Pregnancy Risk Assessment Communication

The Pregnancy Risk Assessment Communication (PRAF) is Ohio Medicaid’s preferred method for providers to notify the state and us of an individual’s pregnancy. You can submit this information via a paper or online form. The online form is called PRAF 2.0.

The PRAF 2.0:

Is the Ohio Department of Medicaid’s preferred notification of pregnancy

Is the only pregnancy notification that automaticallyUpdates Medicaid eligibility, which helps toPrevent loss of Medicaid coverage during pregnancy

Prevent payment delays



Notifies us of a pregnancy

Notifies the home health agency of the need for progesterone

Assesses for additional patient needs



Results in the generation of a progesterone prescription that can be printed and faxed or taken to a pharmacy

Submit the PRAF 2.0

Get the paper PRAF 2.0

Instructions for completing the paper PRAF 2.0

Centers for Disease Control and Prevention HEAR HER campaign

The Centers for Disease Control and Prevention (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

Notification of birth

Please use our Notification of birth form to let us know when one of your patients with Humana Healthy Horizons® in Ohio coverage gives birth. Use this form to report a single birth as well as the delivery of twins or triplets. We will use this information to get a newborn Medicaid ID for each baby.

Notification of birth form

Appalachian Breastfeeding Network

Our members can call the Ohio statewide breastfeeding hotline 24/7, 365 days a year. This service will have Certified Lactation Specialists, Certified Lactation Counselors, and International Board Certified Lactation Consultants available to members for free.

Learn more about Appalachian Breastfeeding Network

