Humana Healthy Horizons® in Oklahoma

A group of young doctors having a conversation in an office

In accordance with the Oklahoma Health Care Authority (OHCA) directive from June 27, 2024, it is essential that all SoonerSelect providers bill the 3 contracted entities (CEs), including Humana Healthy Horizons in Oklahoma, with the provider demographic data that exactly matches the information found on the OHCA’s State Provider Master File.

Which points of data must match correctly on my claim submissions?

When submitting claims to the 3 CEs, including Humana Healthy Horizons in Oklahoma, providers are required to use the same data found on the OHCA’s State Provider Master File for the following items:

Billing National Provider Identifier (NPI)

Rendering NPI, when different from the billing NPI

Billing taxonomy code

Rendering taxonomy code, when different from the billing taxonomy code

Service address (address where services were rendered) with ZIP code +4 digits

Contract code (CN1), if applicable

How can I find the information on file with OHCA for my organization?

The demographic data on file for your hospital, clinic, facility and/or provider office can be found by visiting the OHCA’s provider portal.

How can I update my data?

To update your data with OHCA, login to the OHCA provider portal under the administrator account and select the Update Provider Files link on the portal home page. Please note that OHCA is unable to change your taxonomy code at this time.

If you need to update your data in Availity Essentials™:

Sign in to Availity Essentials.

Select “Manage My Organization.”

Select the correct provider(s).

Make your changes. 

Visit the Availity Help and Training tab for step-by-step instructions. Contact your provider relations representative if you need assistance.

Learn how to submit a corrected claim in Availity Essentials

Providing high-quality care to Oklahoma residents

Through SoonerSelect, the Oklahoma Medicaid managed care program – focused on Temporary Assistance for Needy Families, the Children’s Health Insurance Program, and Medicaid Expansion populations – we will partner with our provider network to serve children and adults across the state with the goal of improving their health and well-being.

By working together, we can help our enrollees:

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

Humana delivers unique value to communities by building on a strong operating model that integrates physical and behavioral healthcare and makes meaningful investments to address the social determinants that affect someone’s health.

We are excited to partner with providers to deliver comprehensive high-quality care to eligible Oklahoma residents with Medicaid coverage, leveraging our innovative and integrated health-delivery platform, long-standing community presence, strong provider partnerships and distinct commitment to improving the health of the populations we serve.

Humana has been serving Sooners since 1987, and today we cover more than 275,000 Oklahoma members across all lines of business, including some of your current Medicaid-eligible patients.

Participation in the Humana Healthy Horizons provider network

If you are contracted, we will be launching new provider orientation and training sessions as part of our onboarding process. Your dedicated provider relations representatives will be reaching out with additional information.

To join our network:

Call:
855-223-9868 (TTY: 711), Monday -  Friday, 8 a.m. -  5 p.m., Central time

Email:
For physical health providers: OKproviderdevelopment@humana.com
For behavioral health providers: OKBHMedicaid@humana.com
For pharmacy health providers: PharmacyContracting@humana.com

Oklahoma providers may join our Medicaid (SoonerSelect) line of business without requirement to join another product/line of business. In accordance with Oklahoma statutes, Humana will never require via policy or contract term an Oklahoma provider to contract for any other line of business as a condition of contracting for Medicaid. If you have questions or concerns, please contact Humana Healthy Horizons’ dedicated Provider Relations team at OKMedicaidProviderRelations@humana.com.

Provider resources

We want to make working with us as easy as possible. We make available the key documents and forms you need to work with us and get paid. Check out the Humana Healthy Horizons in Oklahoma Provider Manual, learn about our claims process, get answers to frequently asked questions, and more.

Download a model Medicaid and Children’s Health Insurance Program (CHIP) managed care addendum for Indian Health Care Providers (IHCP’s)

To help healthcare providers transition to SoonerSelect, Humana will offer a series of provider onboarding and training opportunities.

Our newsletter for Humana Healthy Horizons providers has helpful information for your practice and patients. You can find each new issue posted on this webpage.

On the Horizon Rx is our pharmacy newsletter for prescribers. View the latest edition here.

Oklahoma Health Care Authority (OHCA) Drug Utilization Review (DUR) Board

About Humana

Humana Inc. is committed to helping Humana’s millions of medical and specialty members achieve their best health. Humana’s successful history in care delivery and health plan administration helps us create a new kind of integrated care with the power to improve health and well-being and lower costs. Humana’s efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large.

To accomplish this, Humana supports physicians and other healthcare professionals as they work to deliver the right care in the right place for their patients, our members. Humana’s clinical capabilities, resources and tools—such as in-home care, behavioral health, pharmacy services, data analytics and wellness solutions—combine to produce a simplified experience that makes healthcare easier to navigate and more effective.

Humana Healthy Horizons in Oklahoma is a Medicaid product of Humana Wisconsin Health Organization Insurance Corporation.

Provider validation reminder

Oklahoma Medicaid