Referral, Authorization on the
Way to One-Call Convenience

During 2007, Humana's clinical guidance organization implemented its "Market Centric" initiative, which centralizes and streamlines referral and authorization support within regional divisions.

Each of Humana's four preauthorization and referral units support an assigned market or region. Rather than these functions being segmented, as they have been in the past, one consolidated center provides all preauthorization and referral functions to a region.

"The change should be seamless to providers," said Pati Bliss, R.N., corporate director, clinical intake. "Physician practices will continue to call the number on the back of the member's identification card, and they will be routed automatically to the correct location. The only noticeable difference will be the improved service level."

The reorganization offers several benefits for physician practices. The benefits include the following:

• Convenience of placing a single call to obtain approvals for multiple types of services
• Availability to Humana associates who are more knowledgeable about hospitals and other aspects of medical practices in their assigned region, improving service quality
• Centralized point of contact for practices to reduce complexity and improve outcomes
• Multiple back-up plans

"Providers will talk to the same unit every single time they call," Bliss said. "That consistency will let us get to know providers. As a result, we expect our service can become more personalized."

All Humana preauthorization and referral centers nationwide have had the new model in use since November 1.

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