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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.

Prior authorization resources

The Ohio Medicaid Prior Authorization List includes information about the services that require prior authorization.

Clinical coverage policies are resources for physicians and other Humana-contracted healthcare professionals providing care to our members enrolled in Humana Healthy Horizons in Ohio. Providers should review our clinical coverage policies, which we regularly review and update. Please note that these clinical coverage policies are subject to change.

Review our behavioral and physical health clinical coverage policies


Review our pharmacy clinical coverage policies



Until the Ohio Department of Medicaid fully launches its Ohio Medicaid Enterprise System (OMES), providers who care for Medicaid recipients with coverage through Humana Healthy Horizons® in Ohio will submit prior authorizations via their secure Availity account.

We encourage all providers – participating and non-participating in the Humana Healthy Horizons in Ohio network – to create and utilize a secure Availity account.

Learn how to register for an Availity account and get additional information

After logging into your Availity account, please select “Humana” or “Humana Behavioral Health” from the Payer dropdown before submitting an authorization. This is different from Ohio Medicaid claims. For Ohio Medicaid claims, you must select “Humana Healthy Horizons (Ohio Medicaid) – Payer ID 61103” before submitting claims. 

We will update you once ODM fully launches its OMES and providers must start submitting authorizations through the OMES front door via the ODM Provider Network Management (PNM) portal.

Providers can request prior authorization to exceed coverage or benefit limits for members under the age of 21.

Please use the Ohio Medicaid Community Behavioral Health Authorization Form to ask us to review your request for community behavioral health services. We will be unable to complete a medical necessity and level of care determination without required documentation. Forms can be submitted via Availity Essentials (formerly Availity Portal).

Community behavioral health authorization form

Please use the ODM 10276 “Substance Use Disorder Services Prior Authorization” form when submitting requests for Substance Use Disorder (SUD), Residential Treatment (H2034 and H2036), and Partial Hospitalization (H0015TG).

ODM 10276 “Substance Use Disorder Services Prior Authorization Request” form

Please submit all forms for behavioral health services preauthorization requests through your secure Availity Essentials account.

Ohio Medicaid managed care organizations use Gainwell Technologies as a single pharmacy benefit manager (SPBM). The SPBM utilizes a uniform Preferred Drug List (PDL) and utilization management policies developed by ODM. For more information, call Gainwell at 833-491-0344.

Learn more about prior authorization in the Humana Healthy Horizons in Ohio Provider Manual.

Please submit the Ohio Medicaid Managed Care/MyCare Ohio Nursing facility request form to ask us to review your request for admission to a nursing facility. We will be unable to complete a medical necessity and level of care determination without receiving all required supporting documentation. 

Nursing facility request form

Behavioral and physical health clinical coverage policies

Services that require prior authorization

Clinical coverage policies

Medicaid authorization process

Community behavioral health authorization process

Pharmacy authorization process

Nursing facility request process

Ohio Medicaid