State authorization forms

State-specific authorization request forms

While Humana recommends online submission of authorization requests via Humana.com (registration required) or Availity.com (registration required), the following forms may be used for authorization requests in specific states:

Texas authorization request form
Physicians and other clinicians in Texas may use this form to submit authorization requests for their Humana-covered patients. Instructions are available here. Once complete, please fax it to Humana at 1-800-266-3022. Include supporting clinical documentation (e.g., medical records, progress notes, lab reports, radiology studies, etc.) with your fax form.

Indiana authorization request form
Physicians and other clinicians in Indiana may use this form to submit authorization requests for their Humana-covered patients. Instructions are included on the form. Once complete, please fax it to Humana at 1-800-266-3022. Include supporting clinical documentation (e.g., medical records, progress notes, lab reports, radiology studies, etc.) with your fax form.