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Humana Healthy Horizons in Virginia: how to join, and what to do if you're denied

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Short answer

  • Virginia providers join through Humana's online Request to Join form. Availity credentialing isn't available for Virginia.
  • Our request was denied in two days because Humana said its network already met adequacy standards. A short reconsideration email got it overturned two days later.
  • Humana no longer has a commercial network for employer plans. In Virginia it's Medicaid (Healthy Horizons) and Medicare Advantage.

What the Request to Join needs

  1. Validate the practice with its tax ID, ZIP code and group NPI. This creates your Humana request portal login.
  2. Choose a request type of Request to Join the Network (new contract), the line of service (Medicaid) and the state. Enter the 10-digit DMAS Medicaid provider ID.
  3. Answer the practice questions, including whether you offer office-based addiction treatment (OBAT/MAT).
  4. Attach three documents: Humana's Virginia behavioral health roster template (one row per clinician), a signed Disclosure of Ownership, and the group's W-9.
  5. Submit. You get a tracking number by email, and a contracting rep follows up.

Request Medicare Advantage separately, after the clinician's Medicare enrollment (PECOS) is approved, using Humana's add-network-participation request.

If you're denied because the network is closed

Humana's denial said the Virginia network was closed to more providers in that specialty because it already exceeded state and federal adequacy and access standards. The letter allowed a reconsideration request. Ours worked because it gave Humana reasons that matter to members:

  • Accepting new patients.
  • Telehealth across Virginia as well as in-person visits.
  • Saturday hours as well as weekdays.
  • A language other than English spoken by the clinician.

We emailed it to Humana's Virginia behavioral health contracting mailbox (VA_BH_Medicaid@humana.com) with the request's tracking number. Two days later Humana confirmed the documents were received and sent the request to credentialing. After approval, Humana sends the contract by Adobe Sign for the practice owner to sign.

If you can't appeal, Humana's letter gives the date you can reapply (one year in our case). Put it on your calendar.

TRICARE is separate

Humana Military runs TRICARE East, which has its own steps: TRICARE certification first (up to 90 days), then the network request. It doesn't use the Healthy Horizons request.

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