Sleep study

Facility-based sleep studies

Preauthorization requests for facility-based sleep studies (PSG) are reviewed by HealthHelp®, a nationally recognized specialty benefit management organization. Preauthorization is required for facility-based sleep studies, unless otherwise noted below. The terms prior authorization, precertification, preadmission and preauthorization all 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)
  • Atlanta MA HMO members
  • Health Care Partners commercial and MA HMO members

Other important information

  • For Puerto Rico commercial members, submit preauthorization request by telephone at 1-800-611-1474, or by fax to 1-800-658-9457.
  • For Puerto Rico MA members, submit preauthorization request 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.

Please note: Preauthorization requests for Florida Medicaid members’ facility-based sleep studies (PSG) should be submitted using the instructions on this page.

Submitting preauthorization requests

Humana requires that preauthorization requests for facility-based sleep studies (PSG) be submitted to HealthHelp. As you move through the preauthorization process, you will be prompted to provide the following information:

  • Member name and Humana member ID number
  • Ordering physician name
  • Ordering physician telephone and fax numbers
  • Patient diagnoses or clinical indication [International Classification of Diseases, Ninth Revision (ICD-9) code]
  • Procedure ordered (in-lab diagnostic test)
  • Required clinical data collected from the member (see Clinical Information Form (231 Kb))
  • Additional relevant clinical information, such as evidence of comorbidities, including pulmonary diseases, neuromuscular diseases, congestive heart failure or narcolepsy

Submitting a request by phone

Phone: 1-866-825-1550

Monday through Friday from 7 a.m. to 7 p.m. Central time

Saturday from 7 a.m. to 4 p.m. Central time

Submitting a request online

Practitioners may submit a request to Consult, HealthHelp's online program.

Submitting a request by fax

Preauthorization requests for facility-based sleep studies can also be submitted via fax. Please fax a completed request form (231 Kb) and supporting clinical information to 1-888-863-4464.

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

Obstructive sleep apnea diagnostic management

Learn more about obstructive sleep apnea (238 Kb).

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 Monday through Friday, 8 a.m. to 6 p.m. Central time.

For clinical questions, call 1-866-825-1550. Assistance is available Monday through Friday, 7 a.m. to 7 p.m. Central time, and Saturday, 7 a.m. to 4 p.m.