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processes.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},640724,1793012215,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},137451207643,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","2026  \nProvider Manual  \nHumana Healthy Horizons In Ohio  \nHumana Healthy Horizons in Ohio is a Medicaid product of Humana Health Plan of Ohio, Inc  \nNPC1029306OH0626  \nOHHLQGAEN  \nContents  \nIntroduction 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 8  \nWelcome and thankyou for becoming a participating healthcare provider with Humana Healthy Horizons in Ohio 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 8 Nondiscrimination 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 8 About us 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 9 Humana makes a difference 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 9  \nOur services include 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 9 In addition to the above, our care management programs include 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 10  \nCompliance and ethics 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 10  \nHumana Healthy Horizons established a compliance plan that 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 10 We have the following general compliance and ethics expectations for providers 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 10  \nAccreditation 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 11  \nBasic plan information 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 12  \nGeneral contact information 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 12 Provider representative  \ninformation 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 13  \nProvider resources 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 14  \nHelpful websites 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 14 Availity Essentials 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 14 Member enrollment and eligibility 􀀮􀀮􀀮􀀮 15  \nVerifying eligibility 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 15  \nMedicaid eligibility 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 15 Newborn enrollment 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 15 Disenrollment 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 15 Involuntary dismissal 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 16  \nReferrals for release due to  \nethical reasons 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 17 Automatic renewal 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 18 New member kits 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 18 Member ID cards 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 18  \nMember support services and benefits 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 20 Member Services 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 20 24-hour nurse advice line 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 20 Emergency and crisis behavioral health hotline 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 21  \nBehavioral health crisis hotline 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 21  \nListserv subscriptions 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 21 Claims payment systemic  \nerror report 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 21 Provider engagement council 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 21 Provider policies 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 22  \nProvider Services Call Center information 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 22 Provider training 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 22  \nEducation 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 22 Provider education of required compliance-based materials 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 22 Online training modules 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 23  \nProvider responsibilities􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 25  \nHealth Insurance Portability and Accountability Act and protected health information 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 25  \nPersonally identifiable information and protected health information 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 25 Member privacy 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 25  \nProvider obligations for oral translation, oral interpretation and sign language services 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 26 Cultural competency and  \nlinguistics services 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 26  \nPractical tips for providers 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 27 Clear communication 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 28 Providing culturally appropriate  \ndecision aids 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 28 Subcultures and populations 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 28 Health literacy 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 29 Seniors and people with disabilities 􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮􀀮 29  \nProvider rights an","cbCaikLi0RQdKksk","https://ap.wps.com/l/cbCaikLi0RQdKksk","pdf",1421878,132,"English","# Introduction\n## Welcome and thankyou for becoming a participating healthcare provider\n## Nondiscrimination\n## About us\n## Compliance and ethics\n## Accreditation\n## Provider resources\n## Member enrollment and eligibility\n## Member support services and benefits\n## Provider services call center information\n## Provider responsibilities\n## Provider rights and responsibilities\n## Provider enrollment, credentialing and contracting\n## Provider contracting (MCO functions)","[{\"question\":\"What is Humana Healthy Horizons in Ohio and who is it for?\",\"answer\":\"Humana Healthy Horizons in Ohio is a Medicaid product of Humana Health Plan of Ohio, Inc. The manual is intended for participating healthcare providers.\"},{\"question\":\"What compliance and ethics topics are covered for providers?\",\"answer\":\"The contents include a compliance plan and general compliance and ethics expectations for providers. It also lists provider responsibilities, provider obligations tied to privacy and accessibility-related services, and related guidance.\"},{\"question\":\"How does the manual organize provider and member operations?\",\"answer\":\"It covers provider onboarding and resources, then shifts to member enrollment and eligibility verification, member support services, provider responsibilities and rights, and finally provider enrollment, credentialing, and contracting processes.\"}]","Humana Healthy Horizons in Ohio - Provider Manual - 2026 | PDF",1792710958,333]