Outpatients Procedure

Outpatient echocardiography/coronary angioplasty/stent

Review of outpatient transthoracic echocardiogram (TTE) and outpatient coronary angioplasty/stent procedures is administered by HealthHelp®, a radiology benefit management organization. Please note that prior authorization, precertification, preadmission and preauthorization requirements are all used to refer to the preauthorization process.

Health care providers should use HealthHelp’s RadConsultTM tool to obtain preauthorization for Humana-covered patients' outpatient TTE and outpatient coronary angioplasty/stent procedures.

Exclusions from this requirement include the following:

  • Puerto Rico commercial, Medicaid and Medicare Advantage (MA) members and their providers
  • Florida MA health maintenance organization (HMO) and Medicaid HMO members and their providers
  • Ochsner commercial and MA HMO members and their providers
  • Health Care Partners commercial and MA HMO members and their providers
  • Chicago risk and delegated providers

Submitting preauthorization requests

To submit requests for outpatient TTE and outpatient coronary angioplasty/stent procedures, call 1-866-825-1550. Assistance is available Monday through Friday, 7 a.m. to 7 p.m. CST, and Saturday 9 a.m. to 4 p.m. You may also submit a request via the HealthHelp website. New users should choose “Enroll” under "RadConsult™" to register.

As health care providers move through the authorization process, they will be prompted to provide the following information:

  • Member name and Humana member identification number
  • Ordering physician name
  • Ordering physician telephone and fax numbers
  • Patient diagnoses or clinical indication [International Classification of Diseases, Ninth Revision (ICD-9) code]
  • Procedure ordered (e.g., transthoracic, stress, dobutamine and intravascular echocardiogram; coronary balloon angioplasty or stent)
  • Clinical information supporting procedure request (e.g., presenting symptoms, prior treatment, prior diagnostic testing result, etc.)

Following assessment, an authorization number will be provided, or the health care provider will be contacted for clarification if the information is incomplete or does not meet evidence-based criteria for the procedure requested. HealthHelp will also offer assistance with locating an imaging facility.

Additional resources

Humana cardiology benefit management

Learn more about this program and the patient information required when requesting preauthorization or providing notification.

RadConsult tutorial

Learn how to request, schedule and follow up on imaging services and treatment plans for your Humana-insured patients online with RadConsult by reviewing this tutorial.

Questions

If you have technical questions about the RadConsult preauthorization system, please contact HealthHelp at rcsupport@healthhelp.com or call 1-800-546-7092. Assistance is available Monday through Friday from 8 a.m. to 6 p.m. CST.

For clinical questions, call Humana Radiology Services at 1-866-825-1550. Assistance is available Monday through Friday from 7 a.m. to 7 p.m. CST and Saturday from 9 a.m. to 4 p.m.