Cardiac Implantable device

Cardiac devices

Preauthorization for cardiac implantable devices (e.g., pacemakers, defibrillators and cardiac resynchronization therapy) and wearable defibrillators (e.g., LifeVest®) is administered by HealthHelp®, a nationally recognized benefit management organization. The terms prior authorization, precertification, preadmission, preauthorization and notification are all used to refer to the preauthorization process.

Submitting preauthorization requests

Preauthorization for cardiac devices is required for all commercial and most Medicare members, unless otherwise noted below. It is also required for Humana Integrated Care Program members (Illinois). For Medicare Advantage (MA) Private Fee-for-Service (PFFS) plans, notification is requested, but it is not required. For administrative-services-only (ASO) groups, authorization is not required; but, if it is requested, HealthHelp will manage services.

Exclusions from the preauthorization requirement include the following:

  • 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 RadConsult 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 about prior authorization for cardiac devices 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 (173 KB)

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