Updated Preauthorization

Commercial and Medicare Advantage preauthorization and notification lists updated for 2014

Humana recently notified its contracted health care providers that it has updated its preauthorization and notification lists for all commercial fully insured plans and Medicare Advantage plans. Please note that prior authorization, precertification, preadmission and preauthorization are all used to refer to the preauthorization process. However, for MA Private Fee-for-Service (PFFS) plans, notification is requested, not required. In addition, certain services outlined in the preauthorization and notification lists may not be applicable for providers affiliated with an independent practice association (IPA) via a capitated or delegated arrangement. Health care providers should refer to their provider agreement for clarification or contact Humana for further details.

Health care providers may view the preauthorization and notification lists and find information about the changes to these lists here. This page links to the current Preauthorization and Notification lists and other information. Humana will update the lists when new preauthorization or notification requirements are added and when new drugs or technology enter the market.

Important Changes

  • Chemotherapy was previously added to Humana's Commercial and Medicare Advantage preauthorization and notification lists. Humana is expanding its Oncology Quality Management Program into additional markets, affecting its commercial and Medicare Advantage products for 2014. Humana's Oncology Quality Management Program, administered by New Century Health or Oncology Analytics, includes preauthorization management for chemotherapeutic drugs, symptom management drugs and supportive agents. Affected providers will be contacted prior to the effective date below by their appointed vendor.

    Beginning January 18, 2014, or upon completion of vendor systems and education training (whichever comes first), the Oncology Quality Management Program will become effective in the following markets: Texas, Washington, Oregon, Idaho, Iowa, Nevada, California, Utah, New Mexico, Oklahoma, Arkansas, New Hampshire, Wyoming, Montana, South Dakota, North Dakota, Nebraska, Massachusetts, Pennsylvania, New York, Connecticut, Maine, Delaware, Rhode Island, Mississippi, Alabama, Maryland, New Jersey, Vermont, Alaska and Hawaii. The Oncology Quality Management Program is already effective for Humana's Arizona, Colorado, Florida, Georgia, Illinois, Indiana, Kansas City (Kansas/Missouri), Michigan, Minnesota, North Carolina, South Carolina, Ohio, Kentucky, Louisiana, Tennessee, Virginia, West Virginia and Wisconsin commercial and MA plans.

    For markets assigned to New Century Health, choose one from the following options to submit the chemotherapy treatment request (CTR) form:

    • Initiate an online preauthorization request for an affected drug by logging in to New Century Health's website at my.newcenturyhealth.com. Enter your username and password.
    • Fax the completed CTR form to New Century Health at 1-877-624-0611.
    • Contact New Century Health's pharmacy intake department at 1-855-427-1372, option 5, 8 a.m. to 8 p.m. Eastern time, Monday through Friday.

    Questions about Humana's Oncology Quality Management Program may be directed to New Century Health at 1-855-427-1372, option 5.

    For markets assigned to Oncology Analytics, choose one from the following options to submit the CTR form:

    • Initiate an online preauthorization request for an affected drug by logging in to Oncology Analytics' website at www.oncologyanalytics.com. Choose "Provider Login" at the top of the screen. Please note: physicians must first call 1-888-916-2616 to obtain a username and password.
    • Fax the completed CTR form to Oncology Analytics at 954-622-2431.
    • Contact Oncology Analytics' utilization management department at 1-888-916-2616, 9 a.m. to 5 p.m. Eastern time, Monday through Friday. Physicians may contact an Oncology Analytics medical director from 8 a.m. to 8 p. m. Eastern time, Monday through Friday. The phone number of the on-call physician can be found by calling 1-888-916-2616.

    Keep in mind that preauthorization requests for drugs for noncancer diagnoses that are listed on Humana's preauthorization and notification lists must be directed to Humana's Medication Intake Team (MIT). Medication preauthorization requests may be faxed to MIT at 1-888-447-3430.

    For reauthorization of previously approved chemotherapeutic drugs:

    • Authorizations previously issued by Humana before the applicable effective date will be effective until the authorization expiration date.
    • New authorization requests must be submitted to New Century Health or Oncology Analytics on or after the applicable implementation date.
  • Outpatient transthoracic echocardiogram (TTE) and outpatient coronary angioplasty/stent procedures have been added to Humana's Medicare Advantage (MA) Preauthorization and Notification List. (These services were added to Humana's Commercial Preauthorization and Notification List effective September 14, 2013.) These services will be administered by HealthHelp®, a radiology benefit management organization. These new preauthorization and notification requirements do not apply to inpatient transthoracic echocardiogram (TTE) and inpatient coronary angioplasty/stent procedures.

    You may request preauthorization by logging on to HealthHelp's RadConsult website at http://portal.healthhelp.com/Humana/ or by calling 1-866-825-1550, 7 a.m. to 7 p.m. Central time, Monday through Friday, and 9 a.m. to 4 p.m. Saturday. 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 (e.g., transthoracic, stress, dobutamine and intravascular echocardiogram; coronary balloon angioplasty or stent)
    • Clinical information supporting procedure request (e.g., presenting symptoms, prior treatment, prior diagnostic testing result, etc.)

    Following assessment, an authorization number will be provided, or you will be contacted for clarification if the information is incomplete or does not meet evidence-based criteria for the procedure requested. You will also be offered assistance with locating an imaging facility.

    Questions regarding RadConsult may be directed to 1-866-825-1550.