Facility-based sleep studies

Facility-based sleep studies, also known as polysomnography (PSG), are used to diagnose sleep disorders (sleep apnea, narcolepsy, parasomnias, etc.). Preauthorization of facility-based sleep studies is administered by Humana's clinical intake team (CIT). Please note that precertification, preadmission, preauthorization and prior authorization requirements all refer to the same process of preauthorization.

Preauthorization for facility-based sleep studies

Preauthorization is required for:

  • Commercial fully insured plans
  • Medicare Advantage health maintenance organization (HMO) and preferred provider organization (PPO) plans
  • Dual-eligible Medicare/Medicaid Special Needs Plans
  • Administrative services only members whose groups elect to utilize Humana's standard preauthorization process

The following groups are excluded from the preauthorization requirement but may give notification if they wish to:

  • Medicare Advantage private-fee-for-service plans
  • Medicare Advantage HMO risk groups
  • Medicare Advantage Prescription Drug Plans
  • Medicaid members
  • Puerto Rico members

Health care providers can request preauthorization or provide notification for facility-based sleep testing by contacting the CIT via one of the following methods:

  • Log into the provider self-service center available at Humana.com/providers (registration required); select “Referral & Authorization Submission.”
  • Log into Availity.com (select markets only; registration required); select “Auths and Referrals” from the left navigation menu. Choose “Auth/Referral Inquiry” from the left menu to submit a request.
  • Call Humana's interactive voice response line at 1-800-523-0023: This line is open 24 hours a day for automated precertification requests. Customer service representatives are available to assist you with requests from 8 a.m. to 8 p.m. EST, Monday through Friday (excluding major holidays). Press “0” on your keypad or say “operator” to be connected to a representative. Please have your tax ID number handy when calling.

Preauthorization requirements for administrative-services-only groups vary; please call to determine whether preauthorization is required. Home sleep studies do not require preauthorization.

Questions

Questions about submitting a preauthorization request for facility-based sleep studies may be directed to
Humana at 1-800-523-0023. Customer services representative are available to assist you with requests from
8 a.m. to 8 p.m. EST, Monday through Friday. Press “0” on your keypad or say “operator” to be connected to a
representative. Please have your tax ID number handy when calling.