Preauthorization and Notification Requirements
Precertification, preadmission, preauthorization and notification requirements all refer to the same process of preauthorization. Humana requires preauthorization for most commercial and Medicare Advantage (MA) members. Preauthorization requirements for administrative-services-only groups vary; please call to determine whether preauthorization is required.
For Medicare Advantage (MA) private fee-for-service (PFFS) plans, notification is requested, but not required.
Exclusions from this requirement include the following members and providers:
- HumanaOne® members
- Commercial and MA HMO members assigned to a risk-based or delegated independent physician association (IPA) or physician hospital organization (PHO)
- MA HMO members in Alabama, California, Florida, Georgia, Louisiana, Mississippi, Nevada, North Carolina, South Carolina and Tennessee
- Kentucky Teachers' Retirement System (KTRS) members enrolled in an MA plan
- Puerto Rico members
Submitting Preauthorization Requests
Humana requires that occupational therapy, speech therapy and physical therapy treatment plans ordered for a Humana-insured patient be faxed to OrthoNet at 1-800-863-4061. MA PFFS notifications should also be submitted in this manner.
Learn more about this program and the patient information required when requesting preauthorization or providing notification. This link also provides access to request forms, evaluation forms and other OrthoNet documents.
Questions about this program may be directed to OrthoNet’s provider services department at 1-800-862-4006. Representatives are available to assist callers between 8 a.m. and 8 p.m. Eastern time, Monday through Friday.