Provider Materials

Provider Documents and Forms

Announcements


Update on Humana Home Health Network Services

Humana has contracted with Professional Health Care Network (PHCN) for home health network management services, effective July 1, 2021 for the following Medicare Advantage (MA) networks
Click here to read more…

 

Provider Manual


Home Health Agency Provider Manual:
The PHCN Provider Manual can be used as an operational road map. This document provides an overview of your obligations as a PHCN Provider.

 

Authorization of Services


 

Initial Authorization Request Form:
In-network providers submit this form for an initial authorization request. 

Re-Authorization Request Form:
In-network providers submit this form for a re-authorization request, if needed.

Start of Care Confirmation Form:
Form confirming start of care or resumption of care. Upload this form along with completed OASIS assessment.

Fax Confirmation Form:
Form to confirm fax numbers for authorization and re-authorization requests.

Out of Network Service Notification:
Out-of-network providers submit this form to receive payment for PPO members.

Claims Payment Materials


 

Electronic Funds Transfer (EFT) Enrollment:
Form to enroll in EFT payments. The PHCN payer ID is 26748

Claims Dispute:
Form to dispute denial of a claim.

Provider Information Updates


 

Information change:
In-network providers submit this form to update agency information (TIN, NPI, address, etc.)

 

 

Contact Us:

Please contact the PHCN team with any questions at: Phone: (888) 705-5274.

 

Our Utilization Management (UM) department applies nationally recognized utilization criteria and regionally developed medical policies and standards of care for utilization management reviews. Criteria are available to providers and practitioners upon request by calling (888) 705-5274, faxing (877) 612-7066, emailing casemanagement@prohcn.com or by mail at 7600 N. 16th St. #140, Phoenix, AZ 85020. Once the request is received, our staff will respond with the requested criteria via fax, email or mail.

Interested in learning more?

Contact us about joining the network.