HUMANA

myNEXUS | Humana Inc. Resources

To register for one of our upcoming provider orientations, please visit: https://www.myNEXUScare.com/providerorientation/

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 GA, OK, SC, and TX. Please find important announcements, documents, and forms listed below.

Important announcement: Effective January 1, 2021, myNEXUS will manage Humana Medicare Advantage (MA) plans in the state of Ohio, and select areas of Northern Kentucky. Delegated services will include Utilization Management.

Home health-related requests for in-home skilled nursing, physical therapy, occupational therapy, speech therapy, home health aide, and medical social work will now require pre-authorization from myNEXUS. Claims for home health services for Humana Medicare Advantage Members should be submitted to Humana. This will occur for services administered in a home or residence for Humana Medicare Advantage members in Ohio and select areas of Northern Kentucky.

We will periodically post updates for this program to this page prior to January 1, 2021, and will mail orientation invitation letters over the coming weeks.

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.
Episodic Authorization Form: Fax form to use for Episodic authorization requests if needed.

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

Program Documents

Category Document name Description
Program Materials Updated Humana Plan Grid In-Scope Plan List 11.19.20
Program Materials Initial Authorization Request Form Fax form to use for initial authorization requests.
Program Materials Humana Plan Grid 9.28.20
Program Materials Provider Orientation
Program Materials Re-Authorization Request Form Fax form to use for re-authorization requests.
Program Materials Episodic Authorization Request Form Fax form to use for Episodic provider requests.
Program Materials Fax Confirmation Form Form to complete to confirm fax number for authorization requests.
Program Materials myNEXUS Introduction Orientation letter - Humana OH myNEXUS Introduction Orientation letter for Ohio
Authorization Portal Registration Guide
Authorization Portal Registration Guide Click here for more information on how to register for the portal.
Program Announcements Georgia & South Carolina: September 1, 2019 All home health service requests for Medicare Advantage members starting on or after September 1, 2019 will require prior authorization from myNEXUS.

Humana has mailed out Provider Notification letters to all Providers that provide Home Health Care services.

Additional information regarding upcoming orientation sessions is available on the Orientation page: https://www.mynexuscare.com/providerorientation.
Program Announcements Texas: April 1, 2019 All home health service requests for Medicare Advantage members starting on or after April 1, 2019 will require prior authorization from myNEXUS. myNEXUS will begin accepting authorization requests on March 18, 2019.

Humana has mailed out Provider Notification letters to all Providers that provide Home Health Care services.
Program Announcements Oklahoma & Houston, TX: May 1, 2018 All home health service requests for Medicare Advantage members starting on or after May 1, 2018 will require prior authorization from myNEXUS. myNEXUS will begin accepting authorization requests on April 16, 2018.

Humana has mailed out Provider Notification letters to all Providers that provide Home Health Care services.
Program Announcements Oklahoma & Houston, TX: May 1, 2019 All home health service requests for Medicare Advantage members starting on or after May 1, 2018 will require prior authorization from myNEXUS. myNEXUS will begin accepting authorization requests on April 16, 2018.

Humana has mailed out Provider Notification letters to all Providers that provide Home Health Care services.
Program Announcements Humana OH Announcement
Program Announcements Georgia & South Carolina: September 1, 2019 All home health service requests for Medicare Advantage members starting on or after September 1, 2019 will require prior authorization from myNEXUS.
Humana has mailed out Provider Notification letters to all Providers that provide Home Health Care services.
Additional information regarding upcoming orientation sessions is available on the Orientation page: https://www.mynexuscare.com/providerorientation.
Program Announcements Georgia & South Carolina: September 1, 2020 All home health service requests for Medicare Advantage members starting on or after September 1, 2019 will require prior authorization from myNEXUS.

Humana has mailed out Provider Notification letters to all Providers that provide Home Health Care services.

Additional information regarding upcoming orientation sessions is available on the Orientation page: https://www.mynexuscare.com/providerorientation.