Authorizations and referrals

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

Preauthorization and notification lists

Humana’s electronic referral and authorization tool provides a fast and effective way to submit inpatient and outpatient referrals and authorization requests.

Authorization and referral tool

Humana works with vendors to manage the authorization and referral process for select medical services. The links below offer details on how to request authorization and submit notification for various tests and procedures.

Cardiac catheterization 
Use RadConsult™ to preauthorize or submit notification for cardiac catheterization.

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)
Humana’s Clinical Intake Team (CIT) 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).

Outpatient echocardiography/coronary angioplasty/stent 
Outpatient transthoracic echocardiogram (TTE) and outpatient coronary angioplasty/stent procedures are administered by HealthHelp.

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

Information for providers on medical and pharmacy coverage for new procedures, devices, medications

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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