Cardiac Implantable device

Cardiac devices

Preauthorization requests for cardiac implantable devices (e.g., pacemakers, defibrillators and cardiac resynchronization therapy), external wearable devices (e.g., defibrillator LifeVest®) and cardiac loop recorders (internal/external) are reviewed by HealthHelp®, a nationally recognized benefit management organization. The terms prior authorization, precertification, preadmission and preauthorization 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. For administrative-services-only (ASO) groups, preauthorization is not required; but, if it is requested, HealthHelp will manage services.

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 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.

Submit a request by phone

1-866-825-1550

Available 7 a.m. to 7 p.m. Central time, 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 preauthorization forms

While HealthHelp recommends submission of preauthorization requests online or via telephone, the following forms may be used for preauthorization 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 about preauthorization for cardiac devices may be directed to HealthHelp's 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 9 a.m. to 4 p.m.

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.