Cardiac Caterization

Cardiac imaging, procedures and catheterization

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

  • Outpatient cardiac ablation
  • Transesophageal echocardiogram (TEE)
  • Cardiac computed tomographic angiography (CCTA)
  • Myocardial perfusion imaging single photon emission computed tomography (MPI SPECT)
  • Pulse volume recording
  • Transcatheter valve surgeries (transcatheter aortic valve replacement (TAVR) and MitraClip®)
  • Electrophysiology study (EPS)
  • EPS with 3D mapping
  • Diagnostic cardiac catheterization

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

Submitting preauthorization requests

Preauthorization for outpatient cardiac ablation, TEE, CCTA, MPI SPECT, pulse volume recording, transcatheter valve surgeries (TAVR and MitraClip), EPS and EPS with 3D mapping procedures is required for all commercial fully insured plans (including Humana individual plans), Medicare Advantage (MA) and dual Medicare-Medicaid plans, effective Jan. 18, 2016. For MA private fee-for-service (PFFS) plans, notification is requested, but it is not required.

Exclusions from the preauthorization requirement include:
  • Puerto Rico commercial and MA members
  • 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
  • Illinois Humana Integrated Care Program members

Preauthorization for 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. For MA PFFS plans, notification is requested, but it is not required.

Exclusions from the preauthorization requirement include:

  • Puerto Rico commercial and MA members
  • 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

Submit a request by phone

1-866-825-1550

Available 7 a.m. to 7 p.m. CST, Monday through Friday and 9 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 authorization forms

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

Texas authorization request form (438 Kb)

Physicians and other clinicians in Texas may use this form to submit authorization 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 authorization request form (760 Kb)

Physicians and other clinicians in Indiana may use this form to submit authorization 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 outpatient cardiac ablation, transesophageal echocardiogram (TEE), cardiac computed tomographic angiography (CCTA), myocardial perfusion imaging single photon emission computed tomography (MPI SPECT), pulse volume recording, transcatheter valve surgeries (TAVR and MitraClip), electrophysiology study (EPS), EPS with 3D mapping via HealthHelp may be directed to 1-866-825-1550, 7 a.m. to 7 p.m. Central time, Monday through Friday, and 9 a.m. to 4 p.m., Saturday.

Questions about prior authorization for cardiac catheterization may be directed to RadConsult program support at 1-800-546-7092. Assistance is available Monday through Friday from 7 a.m. to 7 p.m. and Saturday from 9 a.m. to 4 p.m. CST.

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.

(248 KB) Download PDF

English