Inpatient Post-acute Services
Medical management of inpatient post-acute services [skilled nursing facility (SNF), long-term-acute-care hospital (LTACH) and acute rehabilitation (AR) services] for Humana's commercial HMO, POS, PPO and EPO health plan members will be handled by Humana. Please note that Humana already manages these services for its administrative services only (ASO) members, HumanaOne® members, Medicare Advantage members and commercial HMO members assigned to independent physician associations (IPAs) that have a capitated/delegated arrangement with Humana.
Preauthorization for Inpatient Post-acute Services
Health care providers and facilities may submit preauthorization requests for admission to a SNF, LTACH or AR by logging into the secure provider section (enter your User Id and Password in the fields to the left, registration required), via Availity.com (select markets only, registration required) or via the interactive voice response (IVR) line at 1-800-523-0023, 8 a.m. to 8 p.m. Eastern time, Monday through Friday.
During the preauthorization process, you will be prompted to provide the following information:
- Facility tax ID number
- Member name
- Humana member ID number
- Date of birth
- Admission date
- Diagnosis/significant procedure(s) performed (e.g., status post (s/p) total hip replacement)
Please note: Exclusions from this requirement include the following members and providers:
- ASO: Groups not utilizing the standard PAL
- MA: PFFS, Risk Groups, Medicare Advantage Prescription Drug (MAPD) plans
- Other: HumanaOne®, Puerto Rico, Medicaid
Each admission will be assigned a Humana case manager who will collaborate with health care providers' internal staff to facilitate progress toward appropriate and safe discharge planning in the appropriate level of care setting. Please contact Humana before a Humana member is admitted or when requesting a continuation of bed days in a post-acute setting.
Questions
Questions about submitting a preauthorization request or notification for inpatient post-acute services may be directed to Humana at 1-800-523-0023.
