Humana Updates Preauthorization List

As first mentioned in the last issue of Humana’s YourPractice, Humana has updated its Preauthorization and Notification List for commercial fully insured plans (e.g., HMO, PPO, POS and EPO).

Humana publishes this list and updates it periodically. With prior notification (also called precertification or preadmission requirements), Humana can coordinate members’ benefits among specialized programs and offer additional services that may support patients’ well-being.

Who does it apply to?
The following are important notes regarding members who are affected:

• HumanaOne Individual Major Medical Members: Outpatient therapy authorization requirements (physical, occupational and speech therapy) do not apply for HumanaOne members. Check the member’s ID card to verify if the member is enrolled in a HumanaOne plan.
• HMO Members: The preauthorization requirements apply to Humana HMO members. In addition, HMO members may require referrals for care received outside of the primary care physician’s office. Physicians and other health care providers should continue to contact Humana to determine if a referral is needed for services not included on this list.
• Administrative Services Only (ASO) groups: Some employer groups for which Humana provides administrative services only (self-insured, employer-sponsored programs) may customize their plans with different requirements.
• Humana Medicare Advantage: This list does not apply to members of Humana’s Medicare Advantage plans.

Viewing the list
The list is available online or by calling Humana at the number on the back of the member’s ID card.

To view the list online:

• Visit Humana’s Web site at Humana.com.
• Select “Providers,” then “Tools & Resources,” “Provider Tools” and “Clinical & Healthcare Resources.”
• You will find the current Preauthorization and Notification List under the “Download & Print” heading.

How to submit requests
Physician practices can continue to submit requests the same way as they did prior to this update — over the phone or via Humana’s Web portal.

Provider agreements lay out the terms Humana and physicians have agreed upon for which medical services and medications must be preauthorized.

Remember, investigational and experimental procedures are not usually covered benefits. When in doubt, contact Humana.

If you have any questions about preauthorization, call Humana Customer Service at 1-800-4HUMANA (1-800-448-6262).

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