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Review prior authorization lists for services, medications and submission guidance.

Prior authorization submission information

Professionally administered drugs prior authorization

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Prior authorization for professionally administered drugs 

Locate state-specific resources for Humana Healthy Horizons® (Medicaid).

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Medicare Advantage materials

The resources below give healthcare providers information about the types of Medicare Advantage plans Humana offers for individual Medicare beneficiaries. Included are operational and reimbursement guidelines, details about provider qualifications and requirements, frequently asked questions and other information.

The following documents contain information about HMO and HMO point-of-service (HMO-POS) plans and HMO Special Needs Plans (SNPs).

HMO electronic claims flyer

HMO FAQs

2025 and 2024 Humana Medicare Advantage Preferred Provider Organization (PPO) Plan

PPO electronic claims flyer

PPO FAQs

2025 and 2024 Humana Medicare Advantage full and partial networks private-fee-for-service (PFFS) plans

Full and partial networks PFFS electronic claims flyer

Full and partial networks PFFS FAQs

Medicare Advantage PFFS plan model terms and conditions of payment

2023 and 2022 MA Materials (Archive)

HMO

2023 HMO electronic claims flyer / 2023 HMO FAQs

2022 HMO electronic claims flyer / 2022 HMO FAQs

PPO

2023 PPO electronic claims flyer / 2023 PPO FAQs

2022 PPO electronic claims flyer / 2022 PPO FAQs

PFFS

2023 Full and partial networks PFFS electronic claims flyer

2023 Full and partial networks PFFS FAQs

2022 Full and partial networks PFFS electronic claims flyer

2022 Full and partial networks PFFS FAQs

Medicare Advantage Rules of Participation

MA Rules of Participation

Medicare supplement insurance

This document explains Medicare supplement insurance (also known as Medigap) basics. It includes a chart of the standard Medicare supplement plans.

Medicare supplement insurance plans

Medicare Outpatient Observation Notice

When a Medicare beneficiary receives outpatient observation services from a hospital or critical access hospital (CAH) for more than 24 hours, he or she (or the beneficiary’s authorized representative) must receive a Medicare Outpatient Observation Notice (MOON). The written MOON and a verbal explanation of the notice must be delivered no later than 36 hours after services were initiated. The MOON is mandated by the Federal Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act), enacted on Aug. 6, 2015.

Important notes:

The MOON may be delivered before a beneficiary receives 24 hours of observation services as an outpatient

If the beneficiary is transferred, discharged or admitted, the MOON still must be delivered no later than 36 hours following initiation of observation services

The start time of observation services is measured as the clock time observation services are initiated in accordance with a physician’s order

Hospitals and CAHs must use the Office of Management and Budget (OMB)-approved MOON form, which can be downloaded from the Centers for Medicare & Medicaid Services (CMS) website here:



2025 and 2024 Humana Medicare Advantage Health Maintenance Organization (HMO) plan

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