Illinois joint CMS-State sponsored Medicare-Medicaid Alignment Initiative (MMAI)
Treating COVID-19
The Illinois Dept. of Health (IDH) continues to encourage providers to assess patients quickly of the onset of COVID-19 symptoms to determine if they are eligible for one of four available treatments. The IDH asks providers to refer to the
The National Institutes of Health (NIH) COVID-19 Treatment Guidelines recommends ritonavir-boosted nirmatrelvir (Paxlovid), as the preferred treatment for most high-risk, non-hospitalized patients with mild to moderate COVID-19.
You can send prescriptions to federal pharmacy partners and community pharmacies, all of which are listed in the COVID-19 Therapeutic Locator.
The IDH provided the following resources for providers:
Submit all therapeutics orders in the HPoP. Existing providers need to access their account and “Create order.” New therapeutics providers can submit a registration request through the
If you have questions:
- Email dph.mabtherapy@illinois.gov
- Call 800-889-3931
Humana Gold Plus® Integrated Medicare-Medicaid plan prior authorization and notification lists
The document below lists services and medications for which preauthorization may be required for Humana Gold Plus Integrated (Medicare-Medicaid) members. Please review the detailed information atop each list regarding exclusions and other important information before submitting a preauthorization request.
You can also download
Humana claim-payment inquiry resolution guide
To simplify claim payment inquiries, Humana has worked to clarify its process and to ensure that you have the support you need. Refer to the below document to learn more.
Humana Gold Plus Integrated (Medicare-Medicaid) Pharmacy Materials
Learn more about our process for reviewing and giving prior authorization and our step-therapy criteria.
2024 Illinois Prior Authorization Criteria , PDF2024 Illinois Step-Therapy Criteria , PDF2023 Illinois Prior Authorization Criteria , PDF2023 Illinois Step-Therapy Criteria , PDF2022 Illinois Prior Authorization Criteria , PDF2022 Illinois Step-Therapy Criteria , PDF
Centers for Disease Control and Prevention HEAR HER campaign
The Centers for Disease Control and Prevention (CDC) launched recently an initiative called HEAR HER, which includes information, stories, and resources for providers with pregnant patients in their panel. Learn how preventing maternal deaths and complications starts with listening.
Stakeholder Advisory Committee
We invite community partners and stakeholders to join a quarterly virtual Stakeholder Advisory Committee. During our meetings, we encourage participants to:
- Provide feedback on how we’re doing as a health plan
- Share insights into how we can better serve our members
Medicaid Hospice Benefit Election
The Illinois Department of Healthcare and Family Services (HFS) requires the submission of the Medicaid Hospice Benefit Election Standardized Form to HFS for patients with Medicaid and dual Medicare-Medicaid coverage who elect hospice care. Hospice providers must complete the form for each hospice patient.
This form also must be submitted to HFS when a patient dies, ceases hospice care or transfers to another hospice. Use of this form is mandatory. Hospices are asked to allow two weeks after submittal of the HFS 1592 before submitting a claim.
Please visit Illinois government’s
If a patient is covered under an HFS-contracted managed care entity (MCE), hospice providers also must submit a copy of the HFS 1592 form to the MCE.
For patients with Humana Gold Plus Integrated coverage via Humana, please submit a copy of the HFS 1592 form to Humana using one of the following methods:
Email:
Questions regarding this notice should be directed to the hospice’s billing consultant in the Bureau of Comprehensive Health Services at 877-782-5565.