Humana Inc. Implementation Resources
myNEXUS is proud to announce its partnership with Humana, Inc. to provide utilization management for home health services.
Program Announcement (Oklahoma & Houston, TX Only)
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:
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.
Provider Authorization Portal