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.

Current Announcements:

2021 Provider Survey

  • myNEXUS is conducting our annual “myNEXUS Provider Satisfaction Study” over the next few weeks.
  • The survey seeks your valuable input regarding your experiences with myNEXUS.
  • We have retained Gotham Research Group (GRG), a highly respected, independent market research firm, to conduct the survey on our behalf.   All of your responses will be kept completely confidential and will be analyzed only in aggregate with others.  We appreciate your feedback and use it to continue to excel in areas where you are satisfied and improve on opportunities where we can do even better for our valued providers.
  • After you complete the survey, if there are others in your organization who interact with myNEXUS that you think could also provide valuable input, you will be able to share the survey link with them as well.
  • Thank you in advance for taking the time to participate.  We know that your time is valuable and greatly appreciate your willingness to help myNEXUS improve quality and service.

Delegations

  • KY, NJ, PA, WV Delegation: Effective August 1st, 2021, myNEXUS began managing Humana Medicare Advantage (MA) plans in the states of Kentucky, Southern New Jersey, Pennsylvania, and West Virginia. Delegated services include Utilization Management.
  • Orientation Sessions: Orientation training sessions have now ended. Please contact the Provider Network Team for educational materials at provider_network@myNEXUScare.com.
  • Notice: The delegation notice and orientation letter mailed and emailed to agencies is available here.

Agency Information Form:

The agency information form can be 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.
Episodic Authorization Form: Fax form to use for Episodic 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

Program Documents

Category Document name Description
Program Materials Humana Plan Grid 11.2.2021 Humana Plan Grid 11.2.2021
Program Materials myNEXUS Introduction Orientation letter - Humana OH myNEXUS Introduction Orientation letter for Ohio
Program Materials Provider Orientation
Program Materials Fax Confirmation Form Form to complete to confirm fax number for authorization requests.
Program Materials Episodic Authorization Request Form Fax form to use for Episodic provider requests.
Program Materials Re-Authorization Request Form Fax form to use for re-authorization requests.
Program Materials Initial Authorization Request Form Fax form to use for initial authorization requests.
Authorization Portal Registration Guide
Authorization Portal Registration Guide Click here for more information on how to register for the portal.
Program Announcements Humana OH Announcement
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 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 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 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.
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, 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.