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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.

Pharmacy manuals and forms

D.0 Pharmacy Medicaid payer sheet

View the NCPDP Version D.0 Medicaid payer sheet

D.0 Pharmacy Medicare payer sheet

View the NCPDP Version D.0 Medicare payer sheet

D.0 Pharmacy Medicare Prescription Payment Plan payer sheet

View the NCPDP Version D.0 Medicare Prescription Payment Plan payer sheet

D.0 Pharmacy Enclara payer sheet

View the NCPDP Version D.0 Enclara payer sheet

D.0 Limited Income NET (LI NET) Program payer sheet

View the NCPDP Version D.0 LI NET payer sheet

Compliance education and training requirements

Pharmacies contracted with Humana or Humana subsidiaries to support Humana Medicare Advantage and prescription drug plan programs, Medicaid plans, and/or dual Medicare and Medicaid plans must complete compliance training requirements that include, but are not limited to, those outlined by:

Centers for Medicare & Medicaid Services (CMS): upon initial contract and annually thereafter for Medicare-related offerings

Contractual arrangements with states where Humana offers Medicaid and/or dual Medicare and Medicaid plans: annually (when applicable to your organization)

The information below is provided to help pharmacies complete the above requirements:

Compliance Policy

Compliance Policy for Contracted Healthcare Providers and Third Parties – English

Compliance Policy for Contracted Healthcare Providers and Third Parties – Spanish

Humana’s Ethics Every Day for Contracted Healthcare Providers and Third Parties (standards of conduct)

Ethics Every Day – English

Ethics Every Day – Spanish

The above Humana Compliance Policy and Ethics Every Day documents, or materially similar content, must be distributed upon hire/contract and annually thereafter to those who support Humana business. Humana reserves the right to require a contracted pharmacy to submit an attestation form to confirm compliance with this requirement.

Fraud, waste and abuse training and general compliance training

Training on these topics is required by CMS and state Medicaid contracts for Humana network pharmacies supporting Humana's plans for Medicare beneficiaries and Humana-administered plans for Medicaid or dual-eligible (Medicare and Medicaid) beneficiaries.

Your organization is responsible for developing or adopting other content to meet these separate training requirements. The training must be provided to those supporting Humana, upon contract and annually thereafter. Humana reserves the right to require a contracted pharmacy to submit an attestation form to confirm compliance with either of these two training requirements. Additionally, Humana reserves the right to require supporting documentation and evidence that a sufficient process is in place to conduct and track the training.

Note: Attestations may be required for other training.

Manuals and forms

Prior authorizations for professionally administered drugs

Payer sheets

Pharmacy resources