Humana provider enrollment and credentialing guide

How does Humana provider enrollment work in Florida now?

Humana’s commercial exit took in its fully insured, self-funded and federal employee medical plans (Form 10-K for 2025). Florida brings in about a fifth of Humana’s individual Medicare Advantage premiums: about $17.8 billion from 7 contracts covering about 1.0 million of its roughly 5.2 million members at Dec 31, 2025. CMS’s October 2026 file counts 1,162,088 Florida enrollees in Humana plans (38.0% of 3,058,968, the largest share), 170,649 of them in CarePlus, and 101,604 in Miami-Dade (25.6%, second to UnitedHealth Group).

Sources: Humana’s Join our network, Credentialing CAQH and Humana Healthy Horizons in Florida join pages; Form 10-K for 2025; read Oct 20, 2026.

How do I get credentialed with Humana?

In Florida, Medicare, Medicaid and behavioral health providers start with the online form on Humana’s Join our network page, which begins the contract application; Humana says a new form for all states is on the way. The form isn’t for providers with more than one EIN, TIN or billing NPI, or for hospitals, IPAs, PHOs and other complex groups: they write to their regional contracting representative, whose emails the page lists for Florida. Have ready:

• the EIN or TIN, business name and address exactly as on your W-9, and your IRS tax classification;
• each practitioner’s NPI and CAQH number, and a billing NPI name that matches your IRS name;
• billing, claims payment, contracting and correspondence contacts;
• each office address, phone, fax and hours, and where each practitioner practices.

Humana Healthy Horizons in Florida’s own join page gives Medicaid providers a different route: enroll in Florida Medicaid first, through AHCA’s Enrollment Wizard (help line 800-289-7799, option 4), which issues the 9-digit Medicaid provider ID (Florida Medicaid enrollment). Then email the Provider Letter of Interest Request to RequestToJoin@humana.com; long-term care providers write to ltcnetworkrequests@humana.com.

What goes in a Humana provider credentialing application?

Humana requires CAQH ProView, now the CAQH Provider Data Portal. Fill in every field or mark it N/A, list all prior and current practice locations, give your Social Security number, NPI, DEA and license numbers, sign and date the attestation, and upload your CV (work history by month and year), license, DEA and CDS certificates, malpractice face sheet and a summary of pending or settled cases. Then grant Humana access.

Its Credentialing and Recredentialing Policy (28th edition) checks:

• five years of work history, from initial licensure if shorter: a gap over one year explained in writing, a gap of six months to a year verbally or in writing;
• five years of malpractice settlements, from your carrier or the National Practitioner Data Bank;
• a license, and a DEA or CDS certificate, in every state where you treat Humana members; without the certificate, a written statement that you don’t prescribe controlled substances, that your patients don’t need them, and how you handle a patient who does;
• professional liability insurance “in contracted amounts” (Humana publishes no dollar minimum), its liability exception procedure, or Federal Tort Claims Act coverage;
• privileges in good standing at a participating facility, or an explanation of your admitting arrangements;
• no OIG or SAM exclusion on any line of business and, for Medicare, a check of the preclusion and opt-out lists (exclusion checks).

Verifications other than education and training must be recent at the decision (chart below); DEA and CDS certificates are checked before it. For contracted physicians and other health care professionals, the federal rule for Medicare Advantage plans requires a documented process that covers:

“Initial credentialing that includes written application, verification of licensure or certification from primary sources, disciplinary status, eligibility for payment under Medicare, and site visits as appropriate.”

Humana’s own criterion asks you to show current Medicare eligibility, as applicable (Medicare enrollment). Unless a law requires it, Humana doesn’t credential hospital-only practitioners, such as hospitalists, who are neither individually contracted nor in the directory, or covering practitioners without their own relationship with Humana. Practitioners working fewer than 60 calendar days get provisional credentialing, and telehealth practitioners must be licensed where the member is at the time of the visit.

How long does Humana credentialing take for physicians and other practitioners?

Humana acts only on complete applications: it may return an incomplete one unprocessed, and leaving its requests unanswered can end in an administrative denial. The 30-day target applies unless a state or federal rule sets another, and a credentials committee approval comes in writing within 30 calendar days. Credentialing should finish before the contract’s effective date, you appear in the directory only once it is complete, and no practitioner may care for members before being fully credentialed.

Can you appeal a Humana insurance credentialing denial?

It depends on the criterion, and the denial notice gives the reasons:

• Final, with no reconsideration: the administrative criteria, which are education and training, Medicare or Medicaid eligibility, work history, facility privileges, license, DEA or CDS, liability insurance and claims history, OIG or SAM exclusion, and felonies that are crimes of violence or sex offenses. If you think Humana made an error, tell the credentialing team; a denial for a missing DEA certificate or hospital privileges leaves 30 business days to send them.
• Open to reconsideration: license and other adverse actions in the past five years, relinquishing a license or privileges while under investigation, other convictions, impairment and, at recredentialing, quality. Ask in writing within 30 calendar days of the notice; Humana decides in writing within 30 calendar days.

Either way, you can reapply once you meet the criteria.

How do behavioral health providers join the Humana network?

Humana recruits psychiatrists, nurse practitioners certified in behavioral health or psychiatry, social workers, licensed professional counselors, marriage and family therapists, and other behavioral health professionals licensed to practice independently. Humana’s join page names two doors for Florida: the online form (its medical-network section) and the Behavioral Health Provider Inquiry Form (its behavioral health section). In Medicaid, Humana Healthy Horizons runs behavioral health through Carelon Behavioral Health in Regions B to I, Miami-Dade’s Region I among them, and through another partner in Region A, while behavior analysis providers contract with Humana Healthy Horizons directly: send the Letter of Interest with “behavior analysis provider” in the email subject. Therapist routes by license: mental health credentialing; behavior analysts: ABA credentialing.

Keeping Humana credentialing current after approval

• Changes: tell Humana at least 30 days before a change of TIN, NPI, address, hours, phone, practice name, providers joining or leaving, patient restrictions, accepting new patients or Medicare numbers (2026 Provider Manual).
• Every 36 months at most: recredentialing re-verifies your license, DEA or CDS and board certification and rechecks sanctions, including the Medicare preclusion and opt-out lists. Its quality criterion draws on Humana’s quality improvement programs, utilization management, grievances and appeals, and member satisfaction surveys.
• A missed deadline can mean administrative decredentialing; Humana may still recredential within 30 calendar days, after which you start over with initial credentialing.
• After leave: back from active military duty, maternity leave or a sabbatical, you are recredentialed within 60 calendar days. Telehealth practitioners may be recredentialed more often.

Every plan’s cycle on one calendar: recredentialing.

What you can do today

1. Pick your line in the table above: Medicare Advantage, Humana Healthy Horizons or TRICARE.
2. Update CAQH ProView and grant Humana access, with the documents listed above uploaded.
3. Match your names: W-9 legal name and address, IRS classification, and a billing NPI name equal to the IRS name.
4. For Medicaid, finish Florida Medicaid enrollment in the Enrollment Wizard, then email the Letter of Interest to RequestToJoin@humana.com.
5. Adding a provider to a non-delegated group? Note the date the file was complete and book Humana visits in network from 30 days later.
6. Calendar the 36-month recredentialing date and, after any denial, the 30-day reconsideration window.

If you would rather hand it off, our payer enrollment services cover the preparation, submission, monitoring and follow-up of credentialing and enrollment applications.