Negative pressure wound therapy
Preauthorization of negative pressure wound therapy (NPWT) is required for commercial (including members with Humana individual products), Medicaid and Medicare Advantage (MA) health maintenance organization (HMO) and preferred provider organization (PPO) members.
The terms prior authorization, precertification, preadmission and preauthorization are all used to refer to the preauthorization process. For MA private fee-for-service (PFFS) plans, notification is requested, not required.
Humana 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:
- Members treated by Chicago risk and delegated providers.
- Florida Medicare Advantage (MA) health maintenance organization (HMO) and Medicaid HMO members.
- Health Care Partners commercial and MA HMO members
- 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 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.