The interactive voice response (IVR) system gives you several options within one call. Below are answers to some frequently asked questions about the system and its use for preauthorizations. Please note the IVR system may use the term “precertification”; this term has the same meaning as preauthorization.
Q: What is automated preauthorization?
A: It is one of the options on Humana's interactive voice response system. This function enables you to initiate a request for authorization for an inpatient admission and non-HMO (health maintenance organization) outpatient cases. The automated system interfaces with Humana’s host computer systems and allows for faster, more consistent verification of information than a manual system. In most instances, a request can be approved while the caller is on the line.
Q: How do I benefit from using the automated phone system for preauthorization requests?
A: The automated system allows for faster, more consistent verification of information and can approve many requests while the caller is on the line. Once you learn to maximize the system, you can reduce a six-minute call to about a minute. The system is available 24 hours a day, seven days a week.
Q: How do I access the automated system?
A: You access it by dialing the number listed on the back of the patient’s Humana identification (ID) card.
Q: What should I do if the automated system is not available?
A: The system's track record for availability is better than 95 percent. However, if an outage should occur, the system automatically transfers your call to an operator.
Q: What information do I need to enter a preauthorization request?
A: You will need the following information in numeric format:
Q: Can I pause the automated system?
Q: At the beginning of each call, the system prompts me to enter my provider ID. Is my provider ID the same as my federal tax ID number? If so, why is this step necessary?
A: Yes, your federal tax ID number is the same number as your provider ID. This step is necessary to validate your federal tax ID before you are given access to the automated system. This is a security measure to protect patient information.
Q: If I have several preauthorization requests to submit to Humana, do I have to input the facility ID and my phone number with each request?
A: No. The system retains the facility tax ID and your return phone number through multiple cases on the same call. You will be prompted at the end of each case to answer “yes” or press “1” to indicate if you would like to complete another authorization request. That’s when the tax ID and phone number are retained.
Q: Does Humana give preauthorizations for 23-hour observation cases?
A: No. But since a 23-hour observation generally includes an outpatient service for surgery or a medical procedure, please consider the following:
Q: Is there additional information that would be helpful to me when submitting a preauthorization request?
A: Yes. After choosing “inpatient,” you will be asked to identify one of three “places of service” (i.e., “hospital,” “skilled nursing” or “rehabilitation”). These are very important. For example, if you choose “hospital,” the facility ID prompt will not accept the ID number for a skilled nursing or rehab facility. This was designed to keep the facility lists short and save you time.
Q: Occasionally, the hospital list doesn’t present our facility name when I enter the facility tax ID. What should I do in the preauthorization request option?
A: When the hospital cannot be identified from a list, you may opt out to a customer service representative to assist you by saying “operator” or pressing “0.”
Q: What codes are needed for preauthorization requests?
A: The IVR relies on:
The IVR accepts as many as five codes of each type.
Q: Can I enter multiple cases (preauthorization requests) within one session?
A: Yes. At the completion of each case, you have the option to continue with other authorization requests. If you choose to enter more cases for the same facility, you only need to input your name, your call-back number with extension and your facility ID the first time.
Q: Can I check authorization status with the preauthorization option?
A: Yes. The system allows you to check the status of previously submitted requests.
Q: Do I have to wait for the prompts to finish before I can begin entering information?
A: No. Once you are familiar with the questions, you can usually bypass the prompts.
Either way, if the system responds, “I’m sorry, I didn’t understand you,” chances are you need to listen to that particular prompt to get back on track.
Q: What if I have a patient who needs a preoperative day approval?
A: The preauthorization system will prompt you regarding preoperative day requests at the point of entering an elective surgery.