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Prior authorization for professionally administered drugs 

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Provider compliance training materials

Review and confirmation of training materials help practitioners comply with state and federal law, other government requirements, and Humana's policies and procedures. 

Applicable parties must share required information with their employees and, when applicable, with contracted (nonemployee) individuals and any subcontracted entities that support any of the following Humana plan types: Medicare, Medicaid (Humana Healthy Horizons®), Medicare-Medicaid dual plans and Medicare Advantage (MA) Special Needs Plans (SNPs).

Each practitioner in an organization with a direct contract with Humana must complete all required trainings. However, if a practitioner is contracted with Humana only through a group contract, the organization will need to have a person responsible for compliance complete the required trainings.

The following training modules must be completed annually. Read below to determine which modules apply to your practice

Special Needs Plans

Healthcare providers serving any Humana Medicare SNP members, including Chronic Condition SNPs (C-SNPs), Dual Eligible SNPs (D-SNPs), Institutional SNPs (I-SNPs) and Institutional-Equivalent SNPs (IE-SNPs) are required to comply with SNP training. 

Training is available through www.availity.com.

Select Payer Spaces > Humana > Humana Learning Center
Select the category: Compliance trainings
Search for Humana Provider SNP Training 

If you have not yet registered on Availity Essentials™, this document will guide you through the process: Register and Get Started with Availity Essentials - Overview

Humana Healthy Horizons plans or Humana’s duals plan in Illinois

If you are contracted to provide services for a Medicaid plan administered by Humana Healthy Horizons or a Humana duals plan in Illinois, you are required to take the modules below. Your training may include any or all modules, depending on the state(s) in which you are contracted:

Provider Orientation Training

Medicaid Provider Training

Cultural Competency Training

Health, Safety and Welfare Training

Training is available through www.availity.com/
Select Payer Spaces > Humana > Humana Learning Center
Select the category: Compliance trainings
Search for the current year training by state (for any state(s) in which you are contracted). 

If you have not yet registered on Availity Essentials, this document will guide you through the process: Register and Get Started with Availity Essentials - Overview

Cultural Competency Training for Medicare providers

If you are contracted to provide services for a Humana Medicare member, you may access the Humana Medicare Cultural Competency Training through www.availity.com/.

Select Payer Spaces > Humana > Humana Learning Center
Select the category: Compliance trainings
Search for Cultural Competency Training for Medicare Providers

If you have not yet registered on Availity Essentials, this document will guide you through the process: Register and Get Started with Availity Essentials - Overview

Ethics Every Day for Contracted Healthcare Providers and Third Parties (Standards of Conduct)

Ethics Every Day for Contracted Healthcare Providers and Third Parties (Standards of Conduct)

Healthcare providers serving any Humana member are required to review the contents of this document annually. The content is an extension of your organization’s agreement(s) with Humana or a Humana-related entity. This means your organization must comply with what is outlined within the training and provide this publication or an updated, materially similar document to all employees and third parties who support Humana’s Medicare and/or Medicaid products as part of our relationship.

You may also access Ethics Every Day and Compliance Policy www.availity.com/.
Select Payer Spaces > Humana > Humana Learning Center
Select the category: Compliance trainings
Search for Ethics Every Day or Compliance Policy for Contracted Healthcare providers 

Compliance Policy for Contracted Healthcare Providers and Third Parties

This material is applicable to any healthcare provider serving Humana members. The document communicates how to assure an effective compliance program and processes for noncompliance, fraud, waste and abuse prevention, detection, and correction.

Fraud, Waste and Abuse Training

If your organization supports Humana’s MA, prescription drug and/or Medicaid plans, the Centers for Medicare & Medicaid Services (CMS) and Humana require your employees to be trained on fraud, waste and abuse (FWA) at orientation and annually thereafter. 

Your organization can create and train on its own FWA content, or it can use content provided on CMS’ website. Supplemental material for addressing FWA is available in Humana’s Ethics Every Day and Compliance Policy documents above.

*Important: Humana reserves the right to request evidence at any time that an organization’s FWA training is occurring, the organization is tracking the training and the organization has documented processes for the training and tracking.

If a practitioner or anyone employed by or contracted with a Humana-contracted provider suspects actions of noncompliance and/or FWA, he or she must report it immediately. This may be done confidentially via the Ethics Help Line available 24 hours a day, 7 days a week at 877-5THE KEY (584-3539), through the Ethics online-reporting site or by a separate method, preferred by the contracted party, that must then forward the information to Humana promptly.

If you have additional compliance training related questions, please review the FAQs.

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