Peer-to-peer Review Process Changing for Humana Medicare Advantage (MA) Products

Humana is implementing changes to the peer-to-peer review process for its Medicare Advantage health plans.

Effective Aug. 1, 2018, Humana’s time frame for completing a peer-to-peer review is changing. The process then will be:

  • Prior to issuing a medical necessity denial in response to an authorization request for medical service, a Humana representative will call the treating healthcare provider and offer to schedule a peer-to-peer review. The review must take place prior to Humana’s issuance of the denial. Humana will no longer offer peer-to-peer reviews after the denial.
  • Additional clinical information may be submitted at any time prior to the peer-to-peer conversation.

To ensure a timely and effective review of authorization requests for medical services for patients, healthcare providers need to be sure to:

  • Submit all relevant medical records and pertinent information to support the authorization request.
  • Respond promptly to requests for additional information so a timely and effective review can be completed.

Note: The current peer-to-peer review process will remain in place for commercial and Medicaid plans.

For more information, contact Humana Customer Service at 1-800-448-6262 (1-800-4HUMANA).