Q: What's New?
A: You can now access all of our self-service capabilities with just one phone call. Whether you call precertifications at 1-800-523-0023 or Customer Service at 1-800-448-6262 (1-800-4-HUMANA), you will be able to initiate precertifications as well as check on precertification status, get claims or referral status, or check on a member's eligibility and benefits.
Q: What is automated precertification?
A: It is one of the options on Humana's interactive voice response system. The precertification function enables you to initiate a request for authorization for an inpatient admission and non-HMO outpatient precertification. The automated system interfaces with Humana 's host computer systems and allows for faster, more consistent verification of information than a manual system. In most instances, a request is approved while the caller is on the line.
Q: How do I benefit from using the automated phone system for precertifications?
A: The automated system interfaces with Humana's host computer systems and allows for faster, more consistent verification of information than a manual system. In most instances, the precertification request is approved while the caller is on the line. When you learn to maximize the system, you can reduce a six-minute call to about a minute. The system is also available 24 hours a day, seven days a week.
Q: How do I access the automated precertification system?
A: You can access it by dialing 1-800-523-0023 or 1-800-448-6262 (1-800-4-HUMANA) and following the system prompts.
Q: What should I do if the automated system is not available?
A: The system's track record for availability is better than 95 percent. However, if an outage should occur, the system will automatically transfer your call to an operator.
Q: How do I get assistance in learning to use the automated precertification system?
A: Dial either 1-800-523-0023 or 1-800-448-6262 (1-800-4-HUMANA) and either say “operator” or enter “0” on the keypad.
Q: What information do I need in order to enter a precertification?
A: You will need the following information in numeric format:
- Your organization’s federal tax I.D.
- Member’s nine-digit ID
- Members eight-digit date of birth in format mm/dd/yyyy
For precertifications, you'll also need the following:
- Date of service in format mm/dd/yyyy
- Your facility’s main phone number with area code and your extension
- Attending physician ’s phone number/area code/extension
- Nine-digit federal tax ID number for facility
- CPT-4 (five-digit) code for procedures/surgeries
- ICD-9 (three-, four-, or five-digit) codes for diagnoses
- CPT or HCPCS code for outpatient procedures
Q: Can I pause the automated system anywhere?
A: No, not at the present time.
Q: While in the precertification option, if I don’t have all of the information readily available, can I opt out to an operator or agent?
A: Yes. However, we encourage you to utilize the automated line as it will save you time. In most instances, it will give you the authorization while you are still on the line. But, if you should need to speak with a phone team representative, please say “operator,” or enter “0” on the keypad.
Q: At the beginning of each call, the system now prompts me to enter my provider ID. Is my provider ID the same as my federal tax ID number? If so, why is this step necessary?
A: Yes, your federal tax ID number is the same number as your provider ID. This step is necessary to validate your federal tax ID before you are given access to the automated system. This is a security measure to protect patient information.
Q: If I have a string of admissions to do with Humana, do I have to input the facility ID and my phone number with each admission in the precertification option?
A: No. The system now will retain the facility tax ID and your return phone number through multiple cases on the same call. You will be prompted at the end of each case to answer “yes” or press “1 ” to indicate if you would like to do another authorization request. That’s when the tax ID and phone number are retained.
Q: Does Humana give authorization for 23-hour observation?
A: No. But since a 23-hour observation generally includes an outpatient service for surgery or a medical procedure, please consider the following:
- For HMO, check with the PCP or the referral department, as a referral may be required.
- For ASO/PPO, please choose the outpatient option for surgical/procedural observations. Medical observations no longer need to be reported. Please call Humana at 1-800-523-0023 and speak with the Medical Management phone team operator if any observation stay converts to an admission.
Q: Is there additional information that would be helpful to me when doing a precertification?
A: Yes. After choosing “inpatient,” you will be asked to identify one of three “places of service,” i.e. “hospital,” “skilled nursing,” or “rehabilitation.” These are very important. For example, if you choose “hospital,” the facility ID prompt will not accept the ID number for a skilled nursing or rehab facility. This was designed to keep the facility lists short and save you time.
Q: Occasionally, the hospital list doesn’t present our facility name when I enter the facility tax ID. What should I do in the precertification option?
A: When the hospital cannot be identified from a list, you may opt out to a phone team representative to assist you by saying “operator” or pressing “0.”
Q: What codes are needed for precertifications?
A: IVR relies on:
- ICD-9 numeric diagnostic codes only; the system will not accept ICD-9 procedure or V&E codes (example: V222 or E3785).
- CPT-4 codes for procedures.
- HCPCS procedure codes in the alphanumeric form. ** The enhanced IVR now accepts as many as five codes of each type.
Q: Can I enter multiple cases (authorization requests) within one precertification session?
A: Yes. At the completion of each case, you have the option to continue with other precertification authorization requests. If you choose to enter more cases for the same facility, you will only need to input your name, your call-back number with extension and facility ID the first time.
Q: Can I still check authorization status with the precertification option?
A: Yes. The system allows you to check the status of previously submitted requests.
Q: Do I have to wait for the prompts to finish before I can begin entering information?
A: No. Once you are familiar with the questions, you can usually “barge over” the prompts.
- If you use the keypad to respond, you may begin entering your response at any time. Be sure to conclude with the pound (#) sign to save additional time.
- If you like the speech option, interrupting the prompt is a little trickier. Plan to speak when the prompter is not speaking, such as at natural pauses.
Either way, if the system responds, “I’m sorry, I didn’t understand you,” chances are you need to listen to that particular prompt to get back on track.
Q: Can I bypass the initial greeting at 1-800-523-0023 or 1-800-448-6262 (1-800-4HUMANA)?
A: Yes, you can bypass the initial greeting. Just say “Provider” at the initial greeting. However, those messages change from time to time, and you may miss an important enhancement announcement. Even if you are comfortable bypassing the initial greetings, you may want to listen to the messages occasionally to see if there are any new enhancements.
Q: What if I have a patient who needs a preoperative day approval?
A: The precertification system will prompt you regarding preoperative day requests at the point of entering an elective surgery.