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CMS policy results in changes to Humana’s member approval notification process

Due to recent clarification from the Centers for Medicare & Medicaid Services (CMS), Humana is changing its policy regarding enrollee notification for standard organization determinations. To align with CMS’ policy, beginning July 31, 2015, Humana began informing enrollees about the approval of requested medical services via voice-activated technology (VAT) or by mailing them letters.

Previously, Humana relied on health care providers to convey approvals of services to their Humana-covered patients. Per CMS guidelines, as a plan sponsor, Humana must ensure that enrollees are notified of standard organization determinations in a timely manner. The member does not need to take any action regarding these calls or letters, which are simply intended to inform members that the services requested by their doctor have been approved.

Members will be notified by mail if the requested services are not approved.