The interactive voice response (IVR) system gives you several options within 1 call. Below are answers to some FAQs about the system and its use for preauthorizations. Please note the IVR system may use the term “precertification”; this term has the same meaning as preauthorization.
Frequently asked questions
- Q: What is automated preauthorization?
A: It is one of the options on Humana’s IVR system. This function enables you to initiate a request for authorization for an inpatient admission and non-HMO (health maintenance organization) outpatient cases. The automated system interfaces with Humana’s host computer systems and allows for faster, more consistent verification of information than a manual system. In most instances, a request can be approved while the caller is on the line.
- Q: How do I benefit from using the automated phone system for preauthorization requests?
A: The automated system allows for faster, more consistent verification of information and can approve many requests while the caller is on the line. Once you learn to maximize the system, you can reduce a 6-minute call to about a minute. The system is available 24 hours a day, 7 days a week.
- Q: How do I access the automated system?
A: You access it by dialing the number listed on the back of the patient’s Humana member ID card.
- Q: What should I do if the automated system is not available?
A: The system’s track record for availability is better than 95%. However, if an outage should occur, the system automatically transfers your call to an operator.
- Q: What information do I need to enter a preauthorization request?
A: You will need the following information in numeric format:
- Your organization’s Tax Identification Number (TIN) or National Provider Identifier (NPI)
- Member’s 9-digit Humana member ID
- Member’s 8-digit date of birth in the following format: mm/dd/yyyy
- Date of service in the following format: mm/dd/yyyy
- Your facility’s main phone number with area code and your extension
- Attending physician’s phone number/area code/extension
- 9-digit TIN for the facility where services will be rendered
- CPT-4 (5-digit) code for procedures/surgeries
- ICD-10 codes for diagnoses
- CPT or HCPCS code for outpatient procedures
- Q: Can I pause the automated system?
- Q: At the beginning of each call, the system prompts me to enter my provider ID. Is my provider ID the same as my TIN? If so, why is this step necessary?
A: Yes, your TIN is the same number as your provider ID. This step is necessary to validate your TIN before you are given access to the automated system. This is a security measure to protect patient information.
- Q: If I have several preauthorization requests to submit to Humana, do I have to input the facility ID and my phone number with each request?
A: No. The system retains the facility TIN and your return phone number through multiple cases on the same call. You will be prompted at the end of each case to answer “yes” or press “1” to indicate if you would like to complete another authorization request. That’s when the TIN and phone number are retained.
- Q: Does Humana give preauthorizations for 23-hour observation cases?
A: No, but since a 23-hour observation generally includes an outpatient service for surgery or a medical procedure, please consider the following:
- For HMO plans, check with the primary care physician or the referral department, as a referral may be required.
- For self-funded or preferred provider organization plans, please choose the outpatient option for surgical/procedural observations. Medical observations do not need to be reported. Please call Humana at 1-800-523-0023 and speak with the medical management Customer Care operator if any observation stay converts to an admission.
- Q: Is there additional information that would be helpful to me when submitting a preauthorization request?
A: Yes. After choosing “inpatient,” you will be asked to identify 1 of 3 “places of service” (i.e., “hospital,” “skilled nursing” or “rehabilitation”). These are very important. For example, if you choose “hospital,” the facility ID prompt will not accept the ID number for a skilled nursing or rehab facility. This was designed to keep the facility lists short and save you time.
- Q: Occasionally, the hospital list doesn’t present our facility name when I enter the facility TIN. What should I do in the preauthorization request option?
A: When the hospital cannot be identified from a list, you may opt out to a Customer Care specialist to assist you by saying “operator” or pressing “0.”
- Q: What codes are needed for preauthorization requests?
A: The IVR relies on:
- ICD-10 diagnostic codes
- CPT-4 codes for procedures
- HCPCS procedure codes in alphanumeric form.
The IVR accepts as many as 5 codes of each type.
- Q: Can I enter multiple cases (preauthorization requests) within 1 session?
A: Yes. At the completion of each case, you have the option to continue with other authorization requests. If you choose to enter more cases for the same facility, you only need to input your name, your call-back number with extension and your facility ID the first time.
- Q: Can I check authorization status with the preauthorization option?
A: Yes. The system allows you to check the status of previously submitted requests.
- Q: Do I have to wait for the prompts to finish before I can begin entering information?
A: No. Once you are familiar with the questions, you can usually bypass the prompts.
- If you use the keypad to respond, you may begin entering your response at any time. Be sure to conclude with the pound (#) sign to save additional time.
- If you like the speech option, interrupting the prompt is a little trickier. Plan to speak when the prompter is not speaking, such as at natural pauses.
Either way, if the system responds, “I’m sorry, I didn’t understand you,” chances are you need to listen to that particular prompt to get back on track.
- Q: What if I have a patient who needs a preoperative day approval?
A: The preauthorization system will prompt you regarding preoperative day requests at the point of entering an elective surgery.