Please visit , 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:
- Online via , opens new window (registration required)
Please note: Online prior authorization requests are encouraged - By calling Humana’s interactive voice response line at 800-444-9137, Monday – Friday, 8 a.m. – 6 p.m., Eastern time
- By faxing clinical information for a medical service prior authorization request to 833-974-0059 using the
Humana Healthy Horizons in Kentucky Fax Form – State Template, PDF or theHumana Healthy Horizons in Kentucky Fax Form – Humana Preferred Template, PDF - Please submit a
Clinical Trial Attestation Form, PDF with any prior authorization requests for related services
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:
- Call 844-336-2676
- Fax 858-357-2612
- Use the , opens new window, , opens new window, or , opens new window web portals
, 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 888-211-0599
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
Submit authorization requests to eviCore:
- By visiting online at , 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
Effective Sept. 1, 2022, eviCore healthcare will manage physical therapy/occupational therapy/speech therapy services for Humana Healthy Horizons in Kentucky enrollees, including medical necessity reviews on therapy services that occur after an initial evaluation, for all age groups.
Please have the following clinical information available when requesting a preauthorization:
- Patient’s name, date of birth, and Humana member ID number
- Name of requesting and, if applicable, rendering physician or Tax ID Number
- Telephone, email address, and fax numbers of requesting and, if applicable, rendering physician
- Enrollee’s diagnosis
- Clinical information that supports medical necessity need for skilled therapy services (e.g., presenting symptoms, identify new vs. continuing care, primary area of treatment (if applicable, secondary area of treatment), first indictor of complexity, requested dates, functional score, complexity, progress, clinical assessment)
Submit authorization requests to eviCore:
- By visiting online at , 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 855-774-1319
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 , PDF opens new window.
To submit a prior authorization request to New Century Health, you may:
- Initiate an online request by signing in to , 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:
- Use the , opens new window
- Call 855-800-9804, Monday – Friday, 8:30 a.m. – 5:30 p.m., Eastern time
- Fax 888-492-1025