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 authorization requests

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

Additional resources

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

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

Cardiac catheterization 
HealthHelp administers preauthorization requests and notifications for cardiac catheterization through its RadConsult™ tool.

Cardiac devices 
HealthHelp administers preauthorization for cardiac implantable devices (e.g., pacemakers, defibrillators and cardiac resynchronization therapy) and wearable defibrillators (e.g., LifeVest®).

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)
HealthHelp® administers preauthorization for facility-based sleep studies, also known as polysomnography (PSG).

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 for outpatient transthoracic echocardiogram (TTE) and outpatient coronary angioplasty/stent procedures is administered by HealthHelp.

Outpatient therapy
OrthoNet administers preauthorization for occupational therapy, outpatient therapy, physical therapy and speech therapy.

Pain management
OrthoNet administers preauthorization for pain management services.

Radiation therapy
HealthHelp administers preauthorization for radiation therapy.

Radiology services 
Use RadConsult™ to preauthorize or submit notification for radiology services.

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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