On Jan. 18, 2016, Humana will update preauthorization and notification lists for all commercial fully insured plans [e.g., health maintenance organization (HMO), point of service (POS), preferred provider organization (PPO) and exclusive provider organization (EPO)], Medicaid plans and Medicare Advantage (MA) and dual Medicare-Medicaid plans. Please note that prior authorization, precertification, preadmission, preauthorization and notification are all used to refer to the preauthorization process.
For MA Private Fee-for-Service (PFFS) plans, notification is requested, not required. In addition, certain services outlined in the preauthorization and notification lists may not be applicable for Chicago, Nevada or California health care providers affiliated with an independent physician association (IPA) via a capitated arrangement. Health care providers may refer to their provider agreements for additional information or requirements concerning preauthorization.
Preauthorization determinations for these services will be made by HealthHelp®, a nationally recognized specialty benefit management organization.
Preauthorization determinations for these services will be made by OrthoNet®, a utilization management company.
The preauthorization determinations are made by OrthoNet.
The lists are available here. Health care providers also may call the phone number on the back of the member's identification (ID) card to determine if a service requires preauthorization.