Out Patient

Oncology surgery

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:

  • Florida Medicare Advantage (MA) health maintenance organization (HMO) and Medicaid HMO members
  • Atlanta MA HMO members
  • Ochsner commercial and MA HMO members
  • Health Care Partners MA HMO members
  • Chicago risk and delegated providers

Please note:

  • 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.

Submitting 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

Phone: 1-866-825-1550
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:

Texas preauthorization request form (438 Kb)(link opens in new window) 

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.

Indiana preauthorization request form (760 Kb)(link opens in new window) 

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.

Additional resources

Humana Oncology Surgery Benefit Management

Learn more about this program and the member information required when requesting preauthorization.

(71 KB) Download PDF(link opens in new window) 

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) 

Questions

If you have technical questions about the Consult preauthorization system, please contact Consult support staff at rcsupport@healthhelp.com 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.