Humana Inc. Implementation Resources

 

myNEXUS is proud to announce its partnership with Humana, Inc. to provide utilization management for home health 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. A copy of that letter can be found below:

Provider Notification Letter- Texas Market

Additional information regarding upcoming orientation sessions can be found on the Orientation page: https://www.mynexuscare.com/providerorientation.

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. A copy of that letter can be found below:

Provider Notification Letter – Oklahoma Market
Provider Notification Letter – Houston, TX Market

 

Program Materials

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.

In-Scope Plan Names

Initial Authorization Form
Re-Authorization Form
Episodic Authorization Request Form

Provider Authorization Portal

myNEXUS Portal
For information on how to register for the portal, please click this link.

Contact Us

Phone: 1-833-845-8684
Fax: 1-844-438-6791

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