Outpatients Procedure

Outpatient echocardiography and percutaneous coronary intervention (angioplasty/stent)

Preauthorization requests for outpatient transthoracic echocardiogram (TTE) and outpatient percutaneous coronary intervention (angioplasty/stent) are reviewed 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’sConsult tool to obtain preauthorization for Humana-covered patients' outpatient TTE and outpatient percutaneous coronary intervention (angioplasty/stent) procedures.

HealthHelp does not review preauthorization requests for the following, as health care providers who participate in an independent practice association (IPA) or other risk network with delegated services need to refer to their IPA or risk network for guidance on processing preauthorization requests:

  • Florida MA health maintenance organization (HMO) and Medicaid HMO members
  • Atlanta MA HMO members (primary care physician referral required)
  • Ochsner commercial and MA HMO members
  • Health Care Partners commercial and MA HMO members
  • Chicago risk and delegated providers

Other important information

  • For Puerto Rico commercial members, submit preauthorization requests by telephone at 1-800-611-1474, or by fax to 1-800-658-9457.
  • For Puerto Rico MA members, submit preauthorization requests by telephone at 1-866-488-5995 or 1-866-773-5959, or by fax to 1-800-594-5309.
  • For Illinois Humana Integrated Care Program members, preauthorization requests may be submitted using Humana's Interactive Voice Response system (IVR) at 1-800-523-0023. If needed, representatives are available from 8 a.m. to 8 p.m. Eastern time, Monday through Friday.
  • For MA Private Fee-for-Service (PFFS) members, preauthorization is not required. Notification is requested for these plans, but not required, as this helps coordinate care for our members.
  • Preauthorization is not required for services provided by nonparticipating health care providers for MA PPO members. Notification is requested, but not required, as this helps coordinate care for our members.

Submitting preauthorization requests

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

As health care providers move through the preauthorization 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.

State-specific preauthorization forms

While HealthHelp recommends submission of preauthorization requests online or via telephone, the following forms may be used for authorization requests in specific states:

Texas preauthorization request form (438 Kb)

Physicians and other clinicians in Texas may use this form to submit preauthorization requests for their Humana-covered patients. Instructions are available here (127 Kb). Once complete, please fax it to HealthHelp at 1-888-863-4464. Include supporting clinical documentation (e.g., medical records, progress notes, lab reports, radiology studies, etc.) with your fax form.

Indiana preauthorization request form (760 Kb)

Physicians and other clinicians in Indiana may use this form to submit preauthorization requests for their Humana-covered patients. Instructions are included on the form. Once complete, please fax it to HealthHelp at 1-888-863-4464. Include supporting clinical documentation (e.g., medical records, progress notes, lab reports, radiology studies, etc.) with your fax form.

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 Consult by reviewing this tutorial.

Questions

If you have technical questions about the Consult 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. Central time.

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. Central time and Saturday from 7 a.m. to 4 p.m.