Referral

Authorizations and referrals

This page can help you determine which services need preauthorization and how to submit preauthorization and referral requests.

Preauthorization and notification lists

View documents that list services and medications for which preauthorization may be required for patients with Humana Medicaid, Medicare Advantage, dual Medicare-Medicaid and commercial coverage.

Online referrals and preauthorization requests

Learn how to submit requests on Availity.com.

State-specific preauthorization forms

Find forms that may be used by physicians and other healthcare practitioners to submit preauthorization requests in specific states.

Additional resources

The links below offer details on how to request preauthorization and submit notification for various tests and procedures.

Ablation

Preauthorization requests for cardiac ablation/electrophysiology study (EPS) and ablation for bone, liver, kidney and prostate disease are reviewed by HealthHelp®.

Arthroscopy

Preauthorization requests for knee, shoulder and hip arthroscopies are reviewed by OrthoNet.

Behavioral health services

Preauthorization requests for mental health and substance use services for patients with Humana commercial and Medicare Advantage (MA) coverage are managed by Humana Behavioral Health, a wholly owned Humana subsidiary.

Cardiac interventions/devices 

Preauthorization determinations for cardiac interventions and devices are reviewed by HealthHelp.

Chemotherapy agents, supportive drugs and symptom management drugs

Preauthorization is required for chemotherapy agents, supportive drugs and symptom management drugs.

Diagnostic and cardiac imaging

Preauthorization requests for diagnostic and cardiac imaging are reviewed by HealthHelp.

Facility-based sleep studies (PSG) for adults

Preauthorization requests for facility-based sleep studies, also known as polysomnography (PSG), are reviewed by HealthHelp.

Foot surgeries

Preauthorization requests for bunionectomies and hammertoe surgeries are reviewed by OrthoNet.

Molecular diagnostic/genetic testing

Preauthorization is required for services related to molecular diagnostic/genetic testing (MD/GT).

Negative pressure wound therapy (NPWT) 

Preauthorization may be required for initial and continued NPWT services. Forms for initiation and reauthorization of NPWT are available.

Oncology therapy services

Preauthorization requests for oncology therapy services are reviewed by HealthHelp.

Outpatient therapy

Effective Dec. 18, 2017, Humana no longer requires PT/OT/ST preauthorization for patients with Humana MA or commercial coverage.

Pain management

Preauthorization requests for pain management services are reviewed by OrthoNet.

Surgical services 

Preauthorization requests for some surgical services are reviewed by HealthHelp.

Medical and pharmacy coverage policies

Learn more about Humana's Medical and Pharmacy Coverage Policies

Medical and Pharmacy Coverage Policies (opens in new window) 

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