Humana Topic of the Week: Submitting Medicaid Award Letters

Last month, Humana rolled out a new process for DSNP enrollments for those instances when a beneficiary is new to Medicaid, and has a future effective date for their Medicaid. Previously, Humana was unable to accept these enrollments – however this new process allows agents to submit copies of the Medicaid Award Letter to Humana as proof of their future Medicaid.

There are 2 KEY POINTS that must be emphasized going forward for agents that wish to use this new process:

• The AWARD LETTER has a DIFFERENT FAX NUMBER to send to than the Enrollment Application. D-SNP Application Fax # 877-889-9923 and Award Letter Fax # 1-800-633-8188
• The AWARD LETTER has to be SUBMITTED THE SAME DAY as the application, or as close in time as possible to the application. This is a CMS requirement. If the AWARD LETTER is received 3+ days after the application is submitted, Humana cannot accept that AWARD LETTER based on CMS rules and the application will be declined.

Please note that paper applications are not required for these types of enrollments.  You can still use an electronic enrollment tool for the DSNP application, such as Enrollment Hub.  However the award letter will still needs to be submitted by fax or mail.

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Example: 

Agent Faxes both Application and Award Letter to the DSNP FAX # 877-889-9923.  Agent discovers the mistake 7 days later. Agent subsequently faxes Award Letter to correct fax # of 1-800-633-8188.

‍THIS ENROLLMENT WILL BE DECLINED as the Award Letter was not submitted timely to the proper fax number.  The fact that The Award Letter was faxed timely to the wrong fax # is irrelevant.  A new application would have to be written, with a timely submission of Award Letter to the proper Fax # for that application to be approved.

As a reminder, the alternative option is to wait until the Medicaid is active to write the DSNP application.  These applications do not require submission of Medicaid Award Letters, as Humana is able to verify Medicaid status electronically for beneficiaries that have active Medicaid.