Behavioral health services
Preauthorization requests for behavioral health and substance use services for Humana commercial and Medicare members are managed by Humana Behavioral Health, a wholly owned Humana subsidiary. Please note: For Medicare Advantage Private Fee-for-Service (MA PFFS) members and for services provided by nonparticipating health care providers for MA PPO members, preauthorization is not required. Notification is requested for these plans, but not required, as this helps coordinate care for our members.
The following services require preauthorization through Humana Behavioral Health:
- Inpatient hospitalization
- Partial hospitalization
- Residential treatment
- Electroconvulsive Therapy (ECT)
- Applied behavioral analysis (ABA) – Commercial plans only
- Transcranial magnetic stimulation (TMS)
Administrative services only (ASO) clients may purchase a behavioral health services product, such as managed behavioral health or integrated medical and behavioral health, which includes management of preauthorization through Humana Behavioral Health. For ASO clients with outsourced behavioral health management or those who have purchased a network access only product, no utilization or case management services are provided by Humana or its clinical affiliates. Please refer to the member's ID card for appropriate routing of claims or preauthorization inquiries regarding behavioral health services.
Please refer to the member's ID card for appropriate routing of claims or preauthorization inquiries regarding behavioral health services.