The terms prior authorization, precertification, preadmission, preauthorization and notification are all 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 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 this requirement include the following members and providers:
- HumanaOne® members
- 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
- Atlanta MA HMO members
- Kentucky Teachers' Retirement System (KTRS) members enrolled in an MA plan
- Puerto Rico members