The Humana Oncology Quality Management Program, founded on evidence-based care standards, utilizes a counseling model within traditional preauthorization management for chemotherapeutic drugs, symptom-management drugs and supporting agents.
This program is administered by Oncology Analytics for Humana commercial, Medicare Advantage (MA) and some administrative-services-only members in the following states:
- New Hampshire
- New Jersey
- New York
- Rhode Island
- Texas (non-US Oncology practices) (please see below for special instructions)
The terms prior authorization, precertification, preadmission and preauthorization are all used to refer to the preauthorization process.
For MA private fee-for-service (PFFS) members and for services provided by nonparticipating health care providers for MA preferred provider organization members, preauthorization is not required. Notification is requested for these plans, but not required, as this helps coordinate care for our members.
Oncology Analytics does not review preauthorization requests from health care providers who participate in an independent practice association (IPA) or other risk network with delegated services; these health care providers need to refer to their IPA or risk network for guidance on processing preauthorization requests.