Rad preauth

Diagnostic imaging and biopsy services

Preauthorization requests for diagnostic imaging and breast cancer biopsy (excisional) services are reviewed by HealthHelp®, a nationally recognized specialty benefit management organization. Preauthorization is required for diagnostic imaging and breast cancer biopsy (excisional) services. 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 MA health maintenance organization (HMO) and Medicaid HMO members
  • Atlanta MA HMO members (primary care physician referral required)
  • Ochsner commercial and MA HMO members
  • Health Care Partners commercial and MA HMO members
  • Chicago risk and delegated providers

Other important information

  • 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 Illinois Humana Integrated Care Program members, preauthorization requests may be submitted using Humana's Interactive Voice Response system (IVR) at 1-800-523-0023. If needed, representatives are available from 8 a.m. to 8 p.m. Eastern time, Monday through Friday.
  • 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

Preauthorization requests for any diagnostic imaging and breast cancer biopsy (excisional) service ordered for a Humana-covered patient are reviewed through HealthHelp’s online program, Consult, or by phone. These treatment plans include computerized tomography (CT) scans, magnetic resonance angiograms (MRA), magnetic resonance imaging (MRI), nuclear stress tests, positron emission tomography (PET) scans, single-photon emission computerized tomography (SPECT) scans and breast cancer biopsy (excisional)..

Submit a request by phone

Phone: 1-866-825-1550

Available 7 a.m. to 7 p.m. Central time, Monday through Friday and 9 a.m. to 4 p.m., Saturday

Submit a request online

Health care providers may submit a request to Consult, 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)

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). 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)

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 Radiology Benefit Management

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

(194 KB) Download PDF

English

Consult Online tutorial

Learn how to request, schedule and follow up on imaging services and treatment plans for your Humana-insured patients online with Consult Online by reviewing this tutorial.

(1.66 MB) Download PDF

English

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.