Sleep study

Facility-based sleep studies

Preauthorization for facility-based sleep studies (PSG) is administered 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, preauthorization and notification all refer to the preauthorization process.

Exclusions from the preauthorization requirement include the following:

  • Florida Medicare Advantage (MA) health maintenance organization (HMO) members
  • Atlanta MA HMO members
  • Health Care Partners MA HMO members
  • MA HMO-POS and MA PPO out-of-network services
  • MA Private Fee-for-Service (PFFS) plans

For MA PFFS plans and MA HMO-POS and MA PPO out-of-network services, notification is requested, not required.

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 and notifications for facility-based sleep studies (PSG) be submitted to HealthHelp.

As you move through the authorization 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.

Additional resources

Obstructive sleep apnea diagostic 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.