Cardiac Caterization

Diagnostic cardiologic testing, catheterization and interventional cardiology

Preauthorization requests for the following procedures are reviewed by HealthHelp®, a nationally recognized radiology benefit management organization:

  • Cardiac diagnostic imaging:
    • Cardiac computed tomographic angiography (CCTA)
    • Electrophysiology study (EPS)
    • EPS with 3D mapping
    • Transesophageal echocardiogram (TEE)
    • Transthoracic echocardiogram (TTE)
    • Stress echocardiogram
    • Myocardial perfusion imaging single photon emission computed tomography (MPI-SPECT)
    • Cardiac nuclear medicine
  • Cardiac catheterization procedures (outpatient)
    • Diagnostic catheterization
    • Cardiac ablation
    • Percutaneous coronary intervention (PCI, angioplasty/stent)
  • Other cardiac procedures/surgeries
    • Transcatheter valve replacement and repairs [transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve repair (TMVR, MitraClip®)]

The terms prior authorization, precertification, preadmission and preauthorization are all used to refer to the preauthorization process.

Submitting preauthorization requests

Preauthorization for diagnostic cardiologic testing, catheterization and interventional cardiology procedures is required for all commercial fully insured plans (including Humana individual plans), Medicare Advantage (MA) and dual Medicare-Medicaid plans, unless otherwise note below.

HealthHelp does not review preauthorization requests for the following, as health care providers who participate in an independent practice association (IPA) or other risk network with delegated services need to refer to their IPA or risk network for guidance on processing preauthorization requests:

  • Florida MA health maintenance organization (HMO) and Medicaid HMO members
  • Atlanta MA HMO members (primary care physician referral required)
  • Ochsner commercial and MA HMO members
  • Health Care Partners commercial and MA HMO members
  • Chicago risk and delegated providers

Other important information

  • For Puerto Rico commercial members, submit preauthorization requests by telephone at 1-800-611-1474, or by fax to 1-800-658-9457.
  • For Puerto Rico MA members, submit preauthorization requests by telephone at 1-866-488-5995 or 1-866-773-5959, or by fax to 1-800-594-5309.
  • For Illinois Humana Integrated Care Program members, preauthorization requests may be submitted using Humana's Interactive Voice Response system (IVR) at 1-800-523-0023. If needed, representatives are available from 8 a.m. to 8 p.m. Eastern time, Monday through Friday.
  • For MA Private Fee-for-Service (PFFS) members, preauthorization is not required. Notification is requested for these plans, but not required, as this helps coordinate care for our members.
  • Preauthorization is not required for services provided by nonparticipating health care providers for MA PPO members. Notification is requested, but not required, as this helps coordinate care for our members.

Preauthorization for preplanned outpatient cardiac catheterization procedures is required for all commercial and most Medicare members, unless otherwise noted below. It also is required for Illinois Humana Integrated Care Program members.

HealthHelp does not review preauthorization requests for the following, as health care providers who participate in an independent practice association (IPA) or other risk network with delegated services need to refer to their IPA or risk network for guidance on processing preauthorization requests:

  • Florida MA health maintenance organization (HMO) and Medicaid HMO members
  • Atlanta MA HMO members (primary care physician referral required)
  • Ochsner commercial and MA HMO members
  • Health Care Partners commercial and MA HMO members
  • Chicago risk and delegated providers

Other important information

  • For Puerto Rico commercial members, submit preauthorization request by telephone at 1-800-611-1474, or by fax to 1-800-658-9457.
  • For Puerto Rico MA members, submit preauthorization request by telephone at 1-866-488-5995 or 1-866-773-5959, or by fax to 1-800-594-5309.
  • For MA Private Fee-for-Service (PFFS) members, preauthorization is not required. Notification is requested for these plans, but not required, as this helps coordinate care for our members.
  • Preauthorization is not required for services provided by nonparticipating health care providers for MA PPO members. Notification is requested, but not required, as this helps coordinate care for our members.

Submit a request by phone

1-866-825-1550

Available 7 a.m. to 7 p.m. Central time, Monday through Friday and 7 a.m. to 4 p.m., Saturday.

Submit a request online

Health care providers may submit an online request via HealthHelp's Consult online program.

State-specific preauthorization forms

While HealthHelp recommends submission of preauthorization requests online or via telephone, the following forms may be used for authorization requests in specific states:

Texas preauthorization request form (438 Kb)

Physicians and other clinicians in Texas may use this form to submit preauthorization requests for their Humana-covered patients. Instructions are available here (127 Kb). Once complete, please fax it to HealthHelp at 1-888-863-4464. Include supporting clinical documentation (e.g., medical records, progress notes, lab reports, radiology studies, etc.) with your fax form.

Indiana preauthorization request form (760 Kb)

Physicians and other clinicians in Indiana may use this form to submit preauthorization requests for their Humana-covered patients. Instructions are included on the form. Once complete, please fax it to HealthHelp at 1-888-863-4464. Include supporting clinical documentation (e.g., medical records, progress notes, lab reports, radiology studies, etc.) with your fax form.

Questions

Questions regarding preauthorization of diagnostic cardiologic testing and interventional cardiology procedures may be directed to HealthHelp at 1-866-825-1550, 7 a.m. to 7 p.m. Central time, Monday through Friday, and 7 a.m. to 4 p.m., Saturday.

Questions about preauthorization for preplanned outpatient cardiac catheterization may be directed to Consult program support at 1-800-546-7092. Assistance is available Monday through Friday from 7 a.m. to 7 p.m. Central time and Saturday from 7 a.m. to 4 p.m.

Email: rcsupport@healthhelp.com

Additional resources

Humana Cardiology Benefit Management

Learn more about this program and the patient information required when requesting preauthorization or providing notification.

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