Humana Credentialing: How to Join Humana’s Network, Step by Step
Humana’s own process in order: CAQH ProView, the request to join, contracting, committee review and the effective date, plus the Florida route, Availity, Medicare Advantage rules and the status phone line.
Humana credentialing is the review Humana completes before a physician or other provider can join its medical, Medicare Advantage, Medicaid or behavioral health networks: the provider submits a complete CAQH ProView profile and grants Humana access, asks to join through Humana's online form or regional contact, and Humana verifies the file with primary sources and decides at its Credentials Committee, separately from the contract. Humana calls the front door “join our network” and the back half “credentialing”; you need both.
This page follows Humana's own published pages and policy, in the order a practice meets them. For how credentialing differs from enrollment and contracting in general, see what provider credentialing is; for the full multi-payer sequence, see how to get in network with insurance companies.
Updated 2026-10-23. Reviewed by Jacob Greenberg, ClaimCarePro.
Humana credentialing at a glance
Each step, who owns it, and what Humana publishes about it.
| Step | What happens | Who does it | Humana’s published rule |
|---|---|---|---|
| 1. CAQH ProView profile | Complete every section, upload documents, attest, and grant Humana access. | Provider (or credentialing team) | Required by Humana for individual providers; free |
| 2. Request to join | Online form (FL and 11 other listed states, Medicare/Medicaid/BH), regional email elsewhere, or the BH Provider Inquiry Form. | Practice | Florida also: Letter of Interest to RequestToJoin@humana.com |
| 3. Contract application | Humana’s page says to begin the contract application after you have your CAQH ID. | Practice and Humana contracting | Separate from credentialing |
| 4. Verification and committee | Primary-source checks of license, board, malpractice, DEA; Credentials Committee review. | Humana | Committee meets monthly |
| 5. Decision and effective date | Approval or denial notice, then a network effective date. | Humana | Notice within 30 calendar days of the decision |
| 6. Recredentialing | Re-review of the file, using the CAQH profile. | Humana, with the provider | At least every 36 months |
Sources: Humana's join our network and credentialing and CAQH pages, and its credentialing and recredentialing policy (28th edition, last reviewed May 12, 2025).
Who Humana credentials
Humana credentials every participating practitioner who is licensed by the state to practice independently and who has an independent relationship with Humana, meaning Humana directs members to that practitioner. Its policy lists medical doctors, osteopaths, chiropractors, podiatrists, optometrists, oral surgeons, nurse practitioners and physician assistants, plus behavioral health practitioners: psychiatrists, addiction medicine specialists, licensed psychologists, licensed clinical social workers and psychiatric nurse practitioners.
The same policy excludes practitioners who work only inside a hospital or freestanding facility and see members only because the member was sent there (hospital-based anesthesiology, emergency medicine, hospitalists, pathology, radiology and similar), and locum tenens working under 60 calendar days get provisional rather than full credentialing. The policy also covers Humana affiliates, including CarePlus Health Plans and the Humana Behavioral Health Network, so one approved file serves those networks too.
Two timing rules matter for a new practice. Humana's policy says credentialing should be complete before the contract effective date, and a provider prints in the Humana directory only once credentialing is complete. Until then, members cannot find you as in network.
How to get credentialing with Humana: the steps in order
- Get or update your CAQH ProView profile. Humana “requires the use of” CAQH ProView, at no cost to the provider (Arkansas providers are exempt). Every field must be completed or marked N/A, with all prior and current practice locations, your NPI, DEA and license numbers, explanations for any “yes” answers, and a signed, dated attestation. Our CAQH guide covers getting or finding a CAQH number.
- Upload Humana's document list. Humana names: a CV with work history in month/year format, professional license, DEA certificate and state controlled-substance certificate if applicable, the malpractice insurance face sheet, and a summary of any pending or settled malpractice cases.
- Grant Humana access in CAQH. Humana says so in as many words: the application is invisible to Humana until you authorize it.
- Ask to join. If you are a Medicare, Medicaid or behavioral health provider in Florida, Illinois, Indiana, Kentucky, Michigan, Missouri, Ohio, Oklahoma, South Carolina, Virginia, West Virginia or Wisconsin, Humana sends you to its online form. Everywhere else, email your regional representative with the subject line “Join Humana's medical network.” Humana says a new online form for all states is coming.
- Complete the contract application. Humana's CAQH page says that after you receive your CAQH ID, you visit its contracting page to begin a contract application. Credentialing and contracting run as separate tracks.
- Answer Humana's questions fast. If something on the application conflicts with what Humana verified, its policy says you should be notified within 7 days and you have 14 business days to respond. Only the practitioner may attest to an update.
- Committee decision and effective date. The Credentials Committee meets monthly. Once a decision is made, Humana's policy says the practitioner should be notified within 30 calendar days; a denial comes in writing with the reasons.
The paperwork behind steps 1 and 2 is the same set we collect for every payer. Our credentialing intake list puts it in one place so nothing is hunted for mid-application.
Humana credentialing in Florida
Two published routes, depending on the line of business.
Florida appears twice on Humana's pages. Medicare, Medicaid and behavioral health providers in Florida are pointed to the online form on the join our network page. Humana's state contact list separately tells Florida providers to complete the Provider Letter of Interest Request and email it to RequestToJoin@humana.com, with the provider's specialty in the subject line. If you are unsure which applies, the Letter of Interest is the route Humana names for Florida generally.
Humana Healthy Horizons in Florida is Humana's Medicaid plan, and it has its own rule: a March 10, 2026 network notice says that from June 1, 2026, a provider who joins an in-network group that is not delegated for credentialing gets a network effective date 30 days after Humana receives notification and a clean credentialing application, and members seen before that date are generally paid at an out-of-network rate. Florida Medicaid enrollment with the state comes first; the Florida payer-by-payer picture is in our Florida credentialing guide.
Humana and Availity: what the portal does and does not do
Availity Essentials is Humana's provider portal, linked from the top of provider.humana.com, and it is where an in-network practice checks eligibility, submits and tracks claims and requests authorizations. For most individual providers it is not where Humana credentialing happens: Humana's credentialing page names CAQH ProView as the application and a phone line for status.
The exception is some Humana Healthy Horizons Medicaid plans. Humana's Oklahoma credentialing resource guide describes a credentialing application completed on the Availity Essentials portal, with Availity making up to three email attempts to collect missing information before the file goes to primary-source verification. The same guide says providers already approved under Humana's Medicare line still need a current CAQH or Availity application for the Medicaid review, and that credentialing cannot be backdated. Register for Availity early either way; you will need it the day your effective date arrives.
Humana Medicare Advantage: the effective-date rule
The rule that most often costs a new provider money.
Humana's credentialing page carries a notice effective June 13, 2025: providers contracted only with Humana Medicare products who join non-delegated participating groups get a network effective date thirty calendar days after all required documentation is received. Members seen before that date generally have claims paid at an out-of-network level.
In practice, that means a provider joining an existing group should not start seeing Humana Medicare Advantage patients on the assumption that the group's contract covers them. The clock starts when the last required document lands, so an incomplete CAQH profile or a missing malpractice face sheet pushes the date out day for day. Medicare itself does not use CAQH; Original Medicare enrollment runs through PECOS, explained in what PECOS is.
Humana behavioral health credentialing
Humana recruits behavioral health providers through its own route. Its join our network page lists psychiatrists, nurse practitioners in behavioral health or psychiatry, psychologists, social workers, licensed professional counselors, licensed marriage and family therapists, and other behavioral health professionals licensed independently in their state. Most apply with the Behavioral Health Provider Inquiry Form; providers in Indiana, Kentucky, Michigan, Ohio, Oklahoma, Virginia or West Virginia use the online form instead.
The credentialing standards do not change: the same CAQH profile, the same primary-source checks, the same committee. The behavioral health network is a Humana affiliate (Humana Behavioral Health Network) covered by the same policy.
How long does Humana credentialing take?
Only what Humana itself publishes.
Humana does not publish a single national turnaround for credentialing. It publishes these specific clocks, and we do not quote any other:
- Texas commercial HMO networks: written notice of acceptance or non-acceptance within 90 days after Humana receives the application (Credentialing in Texas).
- Colorado: a receipt within 7 calendar days, and an incomplete- application notice within 10 calendar days listing what is missing (Credentialing in Colorado).
- Medicare-only providers joining non-delegated groups: network effective date 30 calendar days after all required documentation is received (credentialing and CAQH page).
- Florida Medicaid, joining an in-network non-delegated group: 30 days after notification and a clean credentialing application, from June 1, 2026 (March 2026 notice).
- After the committee decides: notice within 30 calendar days (policy).
The part no payer publishes is how long the file sits before it is complete. That is the part a practice controls. What other payers publish is compared in our payer credentialing guides.
Why Humana applications stall
In our casework, credentialing stalls most often on bad data from the providers, not on the payer.
| What goes wrong | What it looks like |
|---|---|
| Address on CAQH does not match the request to join | The CAQH profile still lists an old office, or drops a suite number, so Humana sees two locations for one provider. |
| Humana never authorized in CAQH | The profile is complete and attested, but Humana is not checked on the authorization screen, so there is nothing to read. |
| Expired document at verification | A renewed license, DEA or malpractice face sheet never made it into CAQH. Humana’s policy requires credentials to be current at the committee decision. |
| NPI or tax ID mismatch | Individual and group NPIs swapped, or a TIN and legal name that read differently on the W-9, the contract application and CAQH. |
| Work history not in month/year format | Humana asks for a CV with work history in month/year format. Gaps and year-only dates come back as questions. |
| Group not delegated, effective date assumed | A new provider starts seeing Medicare Advantage patients on day one, but the 30-day clock only starts once every required document is in. |
Each one becomes a question from Humana and a file that waits for the answer. The fix is a side-by-side check of CAQH, the request to join, the contract application, the state license record and the W-9 before anything is sent, and then a weekly follow-up call with the rep's name, the date and the reference number logged every time.
How to check Humana credentialing status (and which phone number to call)
To check a Humana credentialing status, call 1-800-626-2741, the number Humana's credentialing page gives for status inquiries. Its policy also gives every practitioner the right, on request, to be told the status of their application, and the right to review the information Humana gathered and correct anything wrong.
| Need | Contact | Source |
|---|---|---|
| Credentialing status | 1-800-626-2741 | Credentialing and CAQH |
| Provider customer service | 800-457-4708 (TTY 711), 8 a.m.–8 p.m. Eastern, Mon–Fri | Join our network |
| Join in Florida (Letter of Interest) | RequestToJoin@humana.com, specialty in subject line | State contact list |
| Humana Healthy Horizons in Florida (Medicaid) | 800-477-6931, 8 a.m.–8 p.m. Eastern, Mon–Fri; FLMedicaidPR@humana.com | March 2026 notice |
| Facility or organization recredentialing | credentialinginquiries@humana.com (recertification form) | Credentialing and CAQH |
| Puerto Rico credentialing | PRCredentials@humana.com or 1-877-384-5037 | Credentialing and CAQH |
When you call, have the provider's NPI, tax ID and CAQH ID ready, write down the rep's name and a reference number, and ask what, specifically, the file is waiting on. “In process” is not an answer you can act on.
Recredentialing with Humana
Humana's policy says it formally recredentials practitioners at least every 36 months, using the CAQH profile. In Wisconsin, Colorado and Massachusetts, Humana is piloting a shared recredentialing process with Elevance and Sutherland Healthcare Solutions: your earliest recredentialing date starts it, and the finished file is shared with the affiliated plans so the dates line up. Humana's instruction is to keep CAQH current and authorized for sharing. The cycles that run alongside it are on recredentialing and credentialing maintenance.
One naming trap: Humana Military is the TRICARE East Region contractor (TRICARE provider FAQ). Searches for “Humana military provider enrollment” are about TRICARE, which has its own certification and network steps, covered in our TRICARE credentialing guide.
Want someone else to run the Humana file?
ClaimCarePro files the Humana application for a flat $250 per payer application, per provider, with weekly follow-up and every call logged. CAQH setup or cleanup is $250, re-credentialing is $250, and maintenance is $99 per provider per year. A new practice can take the bundle: $1,750 per provider ($1,400 for each additional provider on the same group and payers). Full details are on credentialing services, and the team behind it brings 30+ years combined in medical billing.
Prefer to talk first? Call (844) 772-8902.
Humana credentialing questions, answered
What is Humana credentialing?
How do I get credentialing with Humana started?
Is there a Humana credentialing application form?
What is the Humana provider credentialing phone number?
How long does Humana credentialing take?
Does Humana use Availity for credentialing?
Can I see Humana Medicare Advantage patients before my effective date?
How do behavioral health providers join Humana?
How often does Humana recredential providers?
Is Humana Military the same as Humana credentialing?
Sources
- Humana, Join our network (read 2026-10-23).
- Humana, Credentialing and CAQH (read 2026-10-23).
- Humana, Join Our Network state contact list (read 2026-10-23).
- Humana, Policy – Credentialing and Recredentialing, 28th ed. (last reviewed May 12, 2025; read 2026-10-23).
- Humana Healthy Horizons in Florida, Medicaid provider add to existing group network effective date process (March 10, 2026; read 2026-10-23).
- Humana Healthy Horizons in Oklahoma, Credentialing resource guide (read 2026-10-23).
- Humana, Credentialing in Texas and Credentialing in Colorado (read 2026-10-23).
- TRICARE, How does my doctor become a TRICARE provider? (read 2026-10-23).
Updated 2026-10-23. Humana changes its pages; confirm with Humana before relying on a date or contact.