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Preauthorization and notification lists

The documents below list services and medications that require preauthorization for patients with Medicaid, Medicare Advantage, dual Medicare-Medicaid and commercial coverage.

Medicare Commercial Medicaid State-specific preauthorization statistics

Current preauthorization and notification lists

Future preauthorization and notification lists (Effective January 1, 2024)

Future preauthorization and notification lists (Effective February 1, 2024)

Previous preauthorization and notification lists

Preauthorization resources

Use the links below to submit the preauthorization form, find other forms or learn more about the process.

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Coverage criteria

Fax forms

Download a form to submit your preauthorization by fax.

Standard form, PDF

Texas form, PDF

New Mexico form, PDF

Indiana form, PDF

Arizona form, PDF

State exemptions

For more information please see the FAQs below for specific state exemptions.

Texas exemptions

Texas House Bill 3459 – Preauthorization Exemptions, PDF

Louisiana exemptions

Louisiana Senate Bill 112 – Preauthorization Exemptions, PDF

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Provider resources

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Preauthorizations and referrals

Learn how to submit a preauthorizations for your patients with Humana commercial or Medicare coverage.