Update on Humana Home Health Network Services
Humana has contracted with Professional Health Care Network (PHCN) for home health network management services, effective July 1, 2021 for the following Medicare Advantage (MA) networks:
- Arizona – expanding statewide to include preferred provider organization (PPO) members, (existing coverage includes health maintenance organization (HMO) members).
- Colorado – implementing statewide agreement for MA health maintenance organization (HMO) and MA preferred provider organization (PPO) members
- New Mexico – implementing statewide agreement for MA health maintenance organization (HMO) and MA preferred provider organization (PPO) members
This network change requires all home health services to be referred to PHCN to manage, as of July 1, 2021. The program is consistent with industry-wide efforts to ensure clinically appropriate quality of care and to manage the increasing utilization of home health services. While PHCN is responsible for managing service coverage, credentialing and claims adjudication of the home health provider network through contractual relationships with home health agencies in Arizona, Colorado and New Mexico, Humana oversees PHCN through delegation to ensure quality services to its members.
Key Provisions:
- Effective July 1, 2021, the PHCN begins management of all home health referrals for MA HMO and PPO members
- Ordering healthcare providers should contact PHCN to refer members for home health services
- Case managers and concurrent review will to contact PHCN for care plan coordination
- Potential providers requesting home health network participation need to contact PHCN for consideration – see additional information section for contact information
- Providers with credentialing and claims questions should contact PHCN for dates of service on or after July 1, 2021
- Healthcare provider disputes and member grievances and appeals will continue to be managed by Humana
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