The terms prior authorization, precertification, preadmission, preauthorization and notification all are used to refer to the preauthorization process. Humana requires preauthorization for outpatient therapy services for most commercial and Medicare Advantage (MA) members. Preauthorization requirements for administrative-services-only groups and Medicaid members vary; please call Humana at the number on the back of the member’s identification card to determine whether preauthorization is required.
For Medicare Advantage (MA) private fee-for-service (PFFS) plans, notification is requested, but it is not required.
Exclusions from the preauthorization requirement include the following members and health care providers*:
- Members with Humana individual products
- Commercial and MA health maintenance organization (HMO) members assigned to a risk-based or delegated independent physician association (IPA) or physician hospital organization (PHO)
- MA HMO members in Alabama, California, Florida, Georgia, Louisiana, Mississippi, Nevada, North Carolina, South Carolina and Tennessee
- Puerto Rico members
*This is not an all-inclusive list.