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 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 (OA) 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 in order to expedite their internal referral or authorization process.