Behaviour

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.

Submitting preauthorization requests

Save time: Request patient preauthorizations online

For participating providers, Humana Behavioral Health’s online preauthorization tool offers 24-hour access to faster preauthorizations, member benefit information and network status details.

Online Authorization Tool: http://www.onlineauth.com (link opens in new window) 

(Does not require log-in information)

Use the online preauthorization tool to obtain preauthorizations for:

  • Intensive outpatient care
  • Partial hospitalization
  • Acute inpatient psychiatric care
  • Acute inpatient detoxification
  • Psychological and neuropsychological testing
  • Routine outpatient services

The online preauthorization tool is also available via the Humana Behavioral Health provider website at http://www.humanabehavioralhealth.com/providers(link opens in new window).

Submit preauthorizations by phone

Preauthorizations for all levels of care may also be submitted by calling the number on the back of the patient's ID card. Select "mental health" when prompted.

Please note: All requests for preauthorization of residential treatment, eating disorders, autism/ABA, ECT and TMS require telephonic review.

IVR option coming soon

Humana Behavioral Health is developing an automated telephone IVR system, which will provide the option to complete preauthorization requests for standard outpatient services and intensive outpatient services. The system is scheduled for release in 2017.

Submit state-specific inpatient preauthorization requests by fax

The following forms may be used for preauthorization requests in specific states:

Texas preauthorization request form (145 KB)(link opens in new window)

Physicians and other clinicians in Texas may use this form to submit preauthorization requests for their patients with Humana Behavioral Health coverage. Instructions are available here(link opens in new window). Once complete, please fax it to Humana Behavioral Health at 1-800-807-1898. Include supporting clinical documentation (e.g., medical records, progress notes, lab reports, radiology studies, etc.) with your fax form.

Indiana preauthorization request form (761 KB)(link opens in new window)

Physicians and other clinicians in Indiana may use this form to submit inpatient preauthorization requests for their patients with Humana Behavioral Health coverage. Instructions are included on the form. Once complete, please fax it to Humana Behavioral Health at 1-800-807-1898. Include supporting clinical documentation (e.g., medical records, progress notes, lab reports, radiology studies, etc.) with your fax form.

Questions

Questions about preauthorization for behavioral health services may be directed to Humana Behavioral Health support at 1-800-331-9040. Assistance is available Monday through Thursday from 7 a.m. to 6:30 p.m. Central Time, and Friday from 7 to 6 p.m..