The Humana Oncology Quality Management Program, founded on evidence-based care standards, uses a counseling model for the preservice consultation management of chemotherapeutic drugs, symptom management drugs and supporting agents.
This program is administered by OncoHealth for Humana commercial, Medicare Advantage and some Administrative Services Only members in the following U.S. states and territory:
- Florida (excluding certain counties: Alachua, Baker, Bay, Bradford, Calhoun, Charlotte, Citrus, Clay, Collier, Columbia, Dade, DeSoto, Dixie, Duval, Escambia, Flagler, Franklin, Gadsden, Gilchrist, Gulf, Hamilton, Hardee, Hernando, Highlands, Hillsborough, Holmes, Jackson, Jefferson, Lafayette, Lake, Lee, Leon, Levy, Liberty, Madison, Manatee, Marion, Miami, Nassau, Okaloosa, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, St. Johns, Santa Rosa, Sarasota, Seminole, Sumter, Suwannee, Taylor, Union, Volusia, Wakulla, Walton and Washington)
- New Hampshire
- New Jersey
- New York
- Puerto Rico (Medicare)
- Rhode Island
The terms prior authorization, precertification, preadmission and preauthorization are all used to refer to the preauthorization process.
OncoHealth reviews preauthorization requests from healthcare providers who participate in an independent practice association (IPA) or other risk network with delegated services; however, their review is provided to the risk provider to expedite their internal referral or preauthorization process.
Submitting preauthorization requests
Choose from the following options to submit a request for authorization:
- Initiate an online preauthorization request for an affected drug by logging on to the OncoHealth website at
www.oncohealth.us, (participating cancer-care physicians only). Please note: Physicians must call 888-916-2616 to obtain a username and password.
- Fax a completed protocol request form to OncoHealth at 800-264-6128. Please use a secure cover sheet when sending a fax.
Protocol request form, PDF
State-specific preauthorization request forms
If you choose to fax, you can find state-specific forms in the Important Links box at top right on this page. OncoHealth fax: 800-264-6128.
For answers to questions about this program, call 888-916-2616, Monday – Friday, 8:30 a.m. – 6 p.m., Eastern time. Physicians also can contact an OncoHealth medical director at this number. Outside of the stated hours, an on-call medical director will be paged.
Preauthorization and notification lists
View documents that list services and medications for which preauthorization may be required for patients with Humana Medicaid, Medicare Advantage, dual Medicare-Medicaid and commercial coverage.