Healthcare Providers - Authorizations and Referrals

Improved Authorization and Referral Tool

There are some exciting new changes about to take place on the Humana.com authorization and referral system. These changes will provide a faster and more effective way to submit inpatient and outpatient referrals and authorization requests.

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Authorizations / Referrals

Preauthorization and Notification Lists

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Molecular Diagnostic/ Genetic Testing

DNA Direct administers preauthorization for services related to molecular diagnostic/genetic testing (MD/GT)
Radiation Therapy

HealthHelp administers services related to radiation therapy
Pain Management

OrthoNet administers services related to pain managemnet
Outpatient Therapy

OrthoNet administers outpatient therapy, speech therapy, occupational therapy and physical therapy
Radiology Services

Use RadConsult™ for obtaining preauthorization or notification for radiology.
Improved Authorization and Referral Tool

Learn about the new, enhanced Authorization and Referral tools.
Cardiac Catheterization

Use RadConsult™ for obtaining preauthorization or notification for cardiac catheterizaion.
Chemotherapy – Oncology Analytics (Broward County, Dade County, Palm Beach County and Tampa)

To request preauthorization of chemotherapy for members in this area.
Chemotherapy – New Century Health (Chicago, IL; Cincinnati, OH; Kentucky; and Milwaukee, WI)

To request preauthorization of chemotherapy for members in this area.
Cardiac Devices

HealthHelp administers preauthorization for cardiac implantable devices (e.g., pacemakers, defibrillators and cardiac resynchronization therapy) and wearable defibrillators (e.g., LifeVest®).
Facility-Based Sleep Studies (PSG)

Humana’s Clinical Intake Team (CIT) administers preauthorization for facility-based sleep studies, also known as polysomnography (PSG).
Inpatient Post-acute Services

Humana provides medical management of inpatient post-acute services [skilled nursing facility (SNF), long-term-acute-care hospital (LTACH) and acute rehabilitation (AR) services] for its health plan members.