Prior authorization information and routing information

Please visit Humana.com/PAL, opens new window for current and previous prior authorization and notification lists.

Near the bottom of the page, you will find prior authorization guidance from the Kentucky Department for Medicaid Services (KDMS). We strongly urge our providers to review KDMS guidance, which outlines changes to existing procedures as well as when such changes go into effect.

How to request prior authorization for medical services

Except where noted, prior authorization requests for medical services may be initiated:


How to request prior authorization for medications

As of July 1, 2021, MedImpact is the pharmacy benefits manager for all Kentucky health plans offering coverage to Medicaid enrollees. As a result, MedImpact manages all prior authorization requests for medications.

To submit a prior authorization request to MedImpact:


Access prior authorization forms, opens new window to submit authorization requests for your Humana Healthy Horizons in Kentucky/Medicaid-covered patients. Please follow the instructions on the form when completing and submitting it.

Please note: Send all medically billed medication prior authorization requests to Humana Healthy Horizons in Kentucky and New Century Health, as outlined below.

Prior authorization partnerships

Avesis

For authorizations related to dental and vision services

Dental: Call 888-222-0059

Vision: Call 844-511-5760

eviCore healthcare

As of March 1, 2021, Humana Healthy Horizons in Kentucky and eviCore healthcare partnered to provide authorization services for Kentucky Medicaid enrollees for the following advanced imaging services:

  • 3D rendering
  • Computed tomography angiography (CTA)
  • Computerized tomography (CT) scan
  • Magnetic resonance angiography (MRA)
  • Magnetic resonance imaging (MRI)
  • Nuclear medicine
  • Positron emission tomography (PET)
  • Single-photon emission computerized tomography (SPECT) scan

You can submit authorization requests to eviCore:

  • By visiting online at eviCore.com, opens new window (registration required)
  • By calling 866-672-8115, Monday – Friday, 7 a.m. – 7 p.m., Eastern time
  • By faxing your request to 800-540-2406

New Century Health

For adults 18 and older, Humana partners with New Century Health for chemotherapy agent-, supportive- and symptom-management-drug prior authorization requests.

For a list of applicable medications, please see our Prior Authorization List, PDF opens new window.

To submit a prior authorization request to New Century Health, you may:

  • Initiate an online request by signing in to New Century Health’s website, opens new window. If you have not yet received a username and password, please call New Century Health at 855-427-1372, Monday – Friday, 8 a.m. – 8 p.m., Eastern time, and select option 1.
  • Call New Century Health’s Intake Coordinator department at 855-427-1372, Monday – Friday, 8 a.m. – 8 p.m., Eastern time, and select option 1.

WholeHealth Networks (dba Tivity)

Starting October 1, 2021, for all chiropractic services on the KDMS fee schedule, you must get prior authorization through Tivity.

To submit a prior authorization request to Tivity for chiropractic services:


See Chiropractic Service Retro Authorization Policy, PDF opens new window.

Prior authorization updates

KDMS: Prior authorization guidance for SUD residential and inpatient treatment services – May 5, 2022 , PDF

KDMS: Prior authorization guidance for inpatient and outpatient Medicaid services – March 16, 2022 , PDF

Humana: Prior authorization guidance for chiropractic retroactive submissions – Jan. 17, 2022 , PDF

Humana: Prior authorization guidance including Chiropractic Service Partnership – Oct. 1, 2021 , PDF

KDMS: Prior authorization guidance from KDMS – Aug. 12, 2021 , PDF

KDMS: Prior authorization guidance from KDMS – April 26, 2021 , PDF

Humana: eviCore Partnership for Authorization Services , PDF

KDMS: Prior authorization guidance from KDMS – Feb. 1, 2021 , PDF

KDMS: Prior authorization guidance from KDMS – Nov. 17, 2020 , PDF

KDMS: Reinstatement of prior authorization requirements – July 1, 2020 , PDF

Humana: Targeted Case Management prior authorization notice – April 1, 2020 , PDF