Humana Medicare Contracting

The information sheet is submitted first, then Humana sends the electronic contracting link.
If you are already contracted, this sheet allows them to determine if you need a release or not.

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Suggestion: Select both Medicare and HumanaOne on the top of the form.

If you can scan into a PDF file, please send the attachment to:
Can’t scan? Need to fax? Fax to: 1-888-837-5083