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 authorization requests

Learn how to submit requests on and

State-specific authorization forms

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

Additional resources

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


Preauthorization determinations for knee, shoulder and hip arthroscopies are made by OrthoNet.

Behavioral health services

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

Cardiac imaging, procedures and catheterization

Preauthorization determinations for cardiac imaging, procedures and catheterization are made by HealthHelp®.

Cardiac devices 

Preauthorization determinations for cardiac implantable devices (e.g., pacemakers, defibrillators and cardiac resynchronization therapy) and wearable defibrillators (e.g., LifeVest®) are made 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.

Facility-based sleep studies (PSG)

Preauthorization determinations for facility-based sleep studies, also known as polysomnography (PSG), are made by HealthHelp.

Foot surgeries

Preauthorization determinations for bunionectomies and hammertoe surgeries are made 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 reauthorization of NPWT are available.

Outpatient echocardiography/coronary angioplasty/stent

Preauthorization determinations for outpatient transthoracic echocardiogram (TTE) and outpatient coronary angioplasty/stent procedures are made by HealthHelp.

Outpatient therapy

Preauthorization determinations for occupational therapy, outpatient therapy, physical therapy and speech therapy are made by OrthoNet.

Pain management

Preauthorization determinations for pain management services are made by OrthoNet.

Radiation therapy

Preauthorization determinations for radiation therapy are made by HealthHelp.

Radiology services

Preauthorization determinations for radiology services are made 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) 
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