HUMANA

myNEXUS | Humana Inc. Resources

myNEXUS is proud to announce its partnership with Humana, Inc. to provide utilization management for home health services.

myNEXUS has currently partnered with Humana to provide utilization management services in Georgia, Oklahoma, South Carolina, Texas, Ohio, Kentucky, Southern New Jersey, Pennsylvania, and West Virginia. Please find important announcements, documents, and forms listed below.

Agency Information Form:

Please complete the “Agency Information Form” to have your agency’s information added to the myNEXUS system. The form is found online here.

Authorization Program Materials:

In-Scope Plans:
In-Scope Plan List:
 The list of in-scope Humana plans for the myNEXUS delegation.

Authorization Requests:
myNEXUS Provider Portal: myNEXUS encourages providers to utilize the online Provider Portal to submit authorization requests. The Provider Portal can be found online here.

Initial Authorization Request Form: Fax form to use for initial authorization requests if needed.
Re-Authorization Request Form: Fax form to use for re-authorization requests if needed.

Fax Confirmation Form: Online form providers use to confirm their fax numbers for authorization requests.

Additional Information:

myNEXUS utilizes Interqual to facilitate appropriate evaluation of medical necessity by including assessment of the member throughout the continuum of care. A synopsis of the criteria is available to Providers and Members on request and free of charge by calling myNEXUS at 1-833-845-8684 or by emailing provider_network@myNEXUScare.com

 

Contact Us:

Please contact the myNEXUS provider network team with any questions at provider_network@myNEXUScare.com.

Phone: 833-845-8684
Fax: 844-438-6791