Humana Healthy Horizons administers Florida's Behavior Analysis benefit in-house on the AHCA criteria, and differentiates on access: the broadest channel set of the nine plans (Availity Essentials preferred, a 24/7 IVR line, and fax), a dedicated BA provider-relations mailbox with named regional reps, and an unusually explicit rate anchor — absent a letter of agreement, non-participating providers are paid 80% of the Florida Medicaid fee schedule, the figure printed on Humana's own authorization form. For members who change plans, Humana's current flyer commits to “continuing care plan as is for up to 90 days.”
PA is required for all BA services and can be initiated three ways: Availity Essentials (Humana's preferred channel), the 24/7 IVR at 800-523-0023, or fax to 813-321-7220, using Humana's Behavior Analysis Authorization form (1023905FL0616), which Humana says “should be completed and included with your authorization request.” The documentation list tracks the state policy closely: a BA referral and the Comprehensive Diagnostic Evaluation for the initial assessment; then the signed behavior plan, the Vineland-3 and the BASC-3 PRQ for ages 2–18 (at initial assessment and every 12 months), a rationale for the requested hours, and the IEP or 504 plan when services are provided in school. For authorization status, call 866-856-8974. The plan's full PA list lives at Humana.com/PAL. Uniquely among the nine, Humana publishes a dedicated BA provider-relations structure: the FLBA@humana.com mailbox plus named regional representatives covering Regions A–E and F–I — for an intake team, a saved contact sheet turns authorization questions into emails with a named owner. Non-par contracting starts at RequestToJoin@humana.com.[2][3][4]
Participating providers bill at contracted rates (claims via Availity, payer ID 61101; paper to Humana's Lexington, KY claims office), with clean claims processed within 20 days. The notable rate fact: absent a controlling legal requirement or letter of agreement, the current flyer limits non-participating providers to the lesser of “the amount specified by Humana Healthy Horizons in the authorization request form” or “100% of the applicable Medicaid fee schedule,” and the authorization form specifies the amount: non-par providers “will be reimbursed at 80% of the Medicaid Fee Schedule.” That makes the state's low BA rates (97153 at $12.26/unit) the reference point for any Humana negotiation. Continuity of care: for members who change plans, Humana coordinates with the previous plan to honor prior authorizations and commits to “continuing care plan as is for up to 90 days.” The carve-in continuity window of February 2025 has long closed.[2][3]
Florida writes the claim clock for Medicaid health plans, Humana Healthy Horizons included into statute: “Managed care plans shall comply with ss. 641.315, 641.3155, and 641.513” (§ 409.967(2)(j)). Under § 641.3155 a provider must send the claim to the plan “within 6 months after” the date of service (and to a secondary payer within 90 days of the primary’s final determination). For an electronic claim the plan must acknowledge receipt within 24 hours of the next business day and, within 20 days, pay it or notify the provider that it is denied or contested, with an itemized list of what is missing (the provider then has 35 days to supply it). Every claim must be paid or denied within 90 days of receipt, and failure to do so within 120 days “creates an uncontestable obligation to pay the claim.” Paper claims run 40, 120 and 140 days. Late payments bear 12% simple interest.[1][7][8]
Humana’s own 2026 manual: “Providers must submit claims within 6 months of the date of service,” and when Humana is secondary to a payer other than Medicare, “within 90 calendar days of the final determination of the primary payer.” Medicare crossovers cannot be denied for timing unless more than 3 years have passed. Humana publishes no weekly submission cutoff or check-run day.[1][7][8]
The questions that decide whether a family can start with Humana Healthy Horizons in Florida, and what they have to bring. Each maps onto something intake should ask on the first call.
Follows the Florida Medicaid rule: BA is for recipients under the age of 21, with EPSDT available above the coverage-policy and fee-schedule limits. Humana’s BA informational flyer and ABA toolkit publish no plan-specific age limit, and the state policy forbids a plan from applying more stringent service coverage limits.[5][2]
No autism diagnosis is required. Humana’s own instrument clock tracks the state cycle: its Behavior Analysis Authorization form requires the BASC-3 PRQ for ages 2 through 18 and the Vineland-3 Comprehensive Parent Interview Form for all recipients, each at the initial assessment and every 12 months, on top of the state’s reassessment and updated behavior plan at least every six months. The Comprehensive Diagnostic Evaluation itself carries no published expiry.[3][5]
The state rule, restated in Humana’s documentation list: the initial assessment request attaches a referral for BA services and a “comprehensive diagnostic evaluation from a qualified practitioner,” and the behavior plan must carry “the diagnosis and treatment order from the licensed provider,” with the referral coming from an independent physician or qualifying practitioner and the CDE led by a licensed practitioner working within their medical, developmental or psychological scope of practice. Humana publishes no narrower list of its own.[3][5]
Humana’s Behavior Analysis Authorization form names both state instruments as required treatment-request attachments: the Vineland-3 Comprehensive Parent Interview Form for all recipients, plus the Maladaptive Behavior domain for ages 3 and older, and the BASC-3 PRQ for ages 2 through 18 — each “initial assessment and every 12 months.” The state policy requires complete scoring reports.[3][5]
Required, and Humana publishes the fullest documentation list of the nine plans on its Behavior Analysis Authorization form (1023905FL0616): for the initial assessment, a referral for BA services and the Comprehensive Diagnostic Evaluation; for treatment, the behavior plan signed by the lead analyst and parent, medical/developmental and family history, the Vineland-3 and BASC-3 PRQ, “clinical documentation of recommendation for services, outlining rationale for quantity in hours per week/day,” and the IEP or 504 plan when services are provided in school — submitted through Availity Essentials (preferred), the 24/7 IVR at 800-523-0023, or fax 813-321-7220 (authorization status line 866-856-8974). Humana’s current flyer adds that “the Behavior Analysis Authorization form should be completed and included with your authorization request” and that “a valid Medicaid ID is required for all providers, whether located in Florida or out of state, as a condition of payment.”[2][3][5]
Follows the Florida Medicaid rule: the only telemedicine provision is up to two hours per week of Lead Analyst caregiver training (97156) under Rule 59G-1.057, F.A.C. Humana’s BA informational flyer and ABA toolkit publish no telehealth code list, modifier set or place-of-service rule for Florida BA.[5][2]
Ask the plan: Humana’s Florida BA mailbox (FLBA@humana.com) or the provider line 800-477-6931 before scheduling a remote session other than 97156 caregiver training.
Humana’s 2026 Florida provider handbook publishes no decision timeframe for PA requests. Its PA page says only that requests “should be made as soon as possible.” The contract clock therefore applies. The AHCA contract every MMA plan signs sets the clock: plans “shall provide standard authorization decisions within no more than five (5) days following receipt of the request for service,” extendable by “up to four (4) additional days,” and expedited decisions “no later than two (2) days after receipt,” extendable by one day. The contract defines days as calendar days. That is stricter than the federal Medicaid managed-care cap (7 calendar days standard and 72 hours expedited for rating periods from 1/1/2026, 42 CFR 438.210(d)), so the state clock governs. Humana’s BA request must include a current assessment “from within the past 60 days,” so time the reassessment to the submission. No reauthorization lead time is published.[1][10][11]
Humana’s handbook says only: “Humana Healthy Horizons assumes full responsibility for collections in the event of third-party liability.” It publishes no step-by-step rule on billing the other payer first. The state rule that binds every MMA plan still applies. Florida Medicaid pays last. Rule 59G-1.052 says: “Florida Medicaid is the payer of last resort. Providers must exhaust all TPL sources of payment, such as Medicare, TRICARE, private health insurance … prior to submitting or resubmitting a claim.” The AHCA contract binds every MMA plan to that rule. Two consequences for intake: Medicaid pays only “the difference between the Florida Medicaid rate and the third-party payment,” and it pays nothing when “the provider’s TPL claim is denied for failing to obtain the appropriate authorization from the third-party.” So get the commercial plan’s own ABA authorization first.[1][12][11]
Ask the plan: Humana Provider Services (IVR 800-523-0023): whether Humana wants the commercial EOB before its claim, and whether its BA authorization is still required when a commercial plan pays first.
Coverage decides whether Humana Healthy Horizons in Florida pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
The state floor: supervision of BCaBAs and RBTs per the Council of Autism Service Providers practice standards, specified in the supervision plan inside the approved behavior plan, which names the authorized supervisors. Humana adds no ratio or caseload cap — but its authorization form asks for a rationale for the requested hours per week/day with every treatment request, and the provider signs that “the licensed psychologist or BCBA is responsible for all aspects of clinical direction, supervision and case management.”[5][3]
The state rule governs and Humana publishes no variation: the supervisee is not reimbursed when the supervisor is reimbursed for the same time period, and simultaneous services by more than one BA provider are non-covered unless medically necessary, prior authorized and indicated in the approved behavior plan.[5]
Ask the plan: Humana’s Florida BA mailbox (FLBA@humana.com) or the named regional BA representative for whether an authorization may carry 97153 and 97155 on the same clock time.
The state weekly ceiling of up to 40 hours per week of BA intervention as prior-authorized in the behavior plan, with EPSDT available above it and group treatment capped at six participants. Humana bills “reimbursement for all services in 15-minute increments” and requires add-on codes to be billed with the corresponding base code. No per-day unit table is published.[5][2]
Ask the plan: Humana provider services (800-477-6931) for per-day claim edits; the AHCA fee schedule under Rule 59G-4.002 for per-assessment unit caps.
The state rule: session notes signed and dated by the rendering practitioner, carrying date, time, location, duration, behaviors observed, skills targeted, the recipient’s response, protocol modification or therapist direction, an explanation if the parent or guardian was absent, and the participants; the behavior assessment and behavior plan signed by the Lead Analyst and the parent or guardian. Humana publishes no additional signature rule for BA.[5][2]
Humana makes the state school rule an explicit line item on its authorization form — the IEP including BA services, or the 504 plan, “if services are provided in school,” and the form’s place-of-service boxes are Home, Office/Center, School or Other — and the state rule supplies the rest: in the absence of an IEP, documentation justifying the services plus an estimated IEP timeframe; 1:1 shadow, personal care, companion and chaperone services non-covered regardless of setting; travel time non-covered.[3][5]
Humana publishes the box-by-box rule: “use the CMS-1500 form to submit claims for behavioral analysis services”; if the rendering provider is in a group and the group is being paid, “the group will be captured in the billing provider section (Box 33), and then the rendering provider will be captured in the rendering provider section (Box 24)”; if the rendering provider is the one being reimbursed, they go in Box 33; and “enter the individual rendering (treating) provider’s number in Item 24 J… only when it is different from the pay-to provider number.” Claims go out under payer ID 61101 through Availity (paper to the Lexington, KY claims office), clean claims process within 20 days, and, absent a letter of agreement, non-participating providers are paid the lesser of “the amount specified by Humana Healthy Horizons in the authorization request form” or “100% of the applicable Medicaid fee schedule” — and the authorization form itself specifies that non-par providers “will be reimbursed at 80% of the Medicaid Fee Schedule.”[2][3][5]
Six months from the date of service, per Humana’s 2026 Florida Medicaid manual; when Humana pays second to a non-Medicare payer, 90 calendar days from the primary payer’s final determination.
Yes — it administers the state Behavior Analysis benefit on AHCA criteria: no autism diagnosis required, physician referral + order + CDE, PA on all BA services via Availity, 24/7 IVR, or fax.
For the initial assessment, a BA referral and the CDE. For treatment, the signed behavior plan, history and care-coordination notes, the Vineland-3 and BASC-3 PRQ (ages 2–18; initial and every 12 months), a rationale for requested hours, and the IEP/504 for school-based services — all on Humana's Behavior Analysis Authorization form (1023905FL0616).
Absent a letter of agreement, the lesser of the amount on Humana's authorization form or 100% of the Medicaid fee schedule — and the form sets that amount at 80% of the Medicaid Fee Schedule. The state's BA rates are the explicit reference point.
Not published as a yes or no. Florida law lets MMA plans “limit the providers in their networks based on credentials, quality indicators, and price” (s. 409.975(1), F.S.), so a plan may decline a new BA group. Ask Humana Healthy Horizons’s provider relations or contracting team whether it is adding BA groups in your region.
AHCA’s BA coverage policy, which every MMA plan must follow, says “a full assessment may be requested if there is a change in provider,” and a change in a practitioner’s credential (an RBT becoming a BCaBA) is not grounds for a reassessment. Expect the new agency to request its own assessment and treatment authorization; ask Humana Healthy Horizons how it closes the previous provider’s authorization.
Florida law binds Humana Healthy Horizons as an MMA plan (§ 409.967(2)(j) → § 641.3155): pay or send a denial/contest notice within 20 days of an electronic claim (40 for paper), pay or deny within 90 days (120 for paper), and 12% interest on late payments. The statute also requires providers to file within 6 months of the date of service.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.
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