Referral

Authorizations and referrals

This page can help you determine which services need preauthorization and how to submit preauthorization and referral requests.

Preauthorization and notification lists

View documents that list services and medications for which preauthorization may be required for Humana Medicaid, Medicare Advantage, dual Medicare-Medicaid and commercial members.

Online referrals and preauthorization requests

Learn how to submit requests on Humana.com and Availity.com.

State-specific preauthorization forms

Find forms that may be used by physicians and other health care practitioners to submit preauthorization requests in specific states.

Additional resources

The links below offer details on how to request preauthorization and submit notification for various tests and procedures.

Arthroscopy

Preauthorization requests for knee, shoulder and hip arthroscopies are reviewed by OrthoNet.

Behavioral health services

Preauthorization requests for Humana commercial and Medicare Advantage (MA) members' mental health and substance use services are managed by Humana Behavioral Health, a wholly owned Humana subsidiary.

Cardiac devices 

Preauthorization determinations for cardiac implantable devices (e.g., pacemakers, defibrillators and cardiac resynchronization therapy devices) external wearable devices (e.g., defibrillators LifeVest®) and cardiac loop recorders (internal/external) are reviewed by HealthHelp.

Chemotherapy – New Century Health 

Learn how to request preauthorization of chemotherapy for members in select states.

Chemotherapy – Oncology Analytics

Learn how to request preauthorization of chemotherapy for members in select states.

Diagnostic cardiac testing, catheterization and interventional cardiology

Preauthorization requests for diagnostic cardiac testing, catheterization and interventional cardiology are reviewed by HealthHelp®.

Diagnostic imaging and biopsy services

Preauthorization requests for diagnostic imaging and biopsy services are reviewed by HealthHelp.

Facility-based sleep studies (PSG)

Preauthorization requests for facility-based sleep studies, also known as polysomnography (PSG), are reviewed by HealthHelp®.

Foot surgeries

Preauthorization requests for bunionectomies and hammertoe surgeries are reviewed by OrthoNet.

Molecular diagnostic/genetic testing

Preauthorization is required for services related to molecular diagnostic/genetic testing (MD/GT).

Negative pressure wound therapy (NPWT) 

Preauthorization may be required for initial and continued NPWT services. Forms for initiation and repreauthorization of NPWT are available.

Oncology surgery 

Preauthorization requests for oncology surgery are reviewed by HealthHelp®.

Outpatient echocardiography and percutaneous coronary intervention (coronary angioplasty/stent)

Preauthorization requests for outpatient echocardiography and percutaneous coronary intervention (coronary angioplasty and stent) are reviewed by HealthHelp®.

Outpatient therapy

Preauthorization requests for occupational therapy, outpatient therapy, physical therapy and speech therapy are reviewed by OrthoNet.

Pain management

Preauthorization requests for pain management services are reviewed by OrthoNet.

Radiation therapy

Preauthorization requests for radiation therapy are reviewed by HealthHelp®.

Medical and pharmacy coverage policies

Medical and pharmacy coverage policies

Learn more about Humana's Medical and Pharmacy Coverage Policies

Medical and Pharmacy Coverage Policies (link opens in new window) 
Learn about new tools and resources

Learn about new tools and resources

Find information on the newest tools for healthcare providers.

See what’s new
Newsletter and tools for health care providers to save time, increase efficiency and productivity

Read our provider magazine

Humana’s publication for office staff and healthcare providers has updates on news and tools to make it easier for you to do business with us.

Browse Humana’s YourPractice now