Preauthorization is required for breast lumpectomy services, unless otherwise noted below. Preauthorization requests for oncology surgery are reviewed by HealthHelp, a nationally recognized specialty benefit management organization. The terms prior authorization, precertification, preadmission and preauthorization are all used to refer to the preauthorization process.
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:
Humana requires that breast lumpectomy preauthorization requests be submitted to HealthHelp. These requirements apply to breast lumpectomy (retained mastectomy partial and partial with lymphadenectomy) procedures.
Submitting a request by phone
Monday – Friday from 7 a.m. to 7 p.m. Central time
Saturday from 9 a.m. to 4 p.m.
Submitting a request online
Health care professionals may submit a request to Consult(link opens in new window) , HealthHelp's 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:
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)(link opens in new window) . 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.
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.
Humana Oncology Surgery Benefit Management
Learn more about this program and the member information required when requesting preauthorization.
Consult Online tutorial
Learn how to request, schedule and follow up on imaging services and treatment plans for your Humana members online with Consult Online by reviewing this tutorial.
(1.66 MB) Download PDF
English(link opens in new window)
If you have technical questions about the Consult preauthorization system, please contact Consult support staff at firstname.lastname@example.org or call 1-800-546-7092. Assistance is available from 8 a.m. to 6 p.m. Central time, Monday through Friday.
For clinical questions, call 1-866-825-1550. Assistance is available from 7 a.m. to 7 p.m. Central time, Monday through Friday and from 9 a.m. to 4 p.m., Saturday.