The links below offer details on how to request preauthorization and submit notification for various tests and procedures.
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.
Preauthorization determinations for cardiac implantable devices (e.g., pacemakers, leadless pacemakers, left atrial appendage closure devices, defibrillators, cardiac resynchronization therapy devices) and ventricular assist devices (VAD); external wearable devices (e.g., defibrillators LifeVest®); and cardiac loop recorders (internal/external) 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 interventional cardiology
Preauthorization requests for diagnostic cardiology, catheterization and interventional cardiology are reviewed by HealthHelp®.
Preauthorization requests for diagnostic imaging are reviewed by HealthHelp.
Facility-based sleep studies (PSG)
Preauthorization requests for facility-based sleep studies, also known as polysomnography (PSG), are reviewed by HealthHelp®.
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 surgery and biopsy services
Preauthorization requests for oncology surgery (breast lumpectomy, simple mastectomy and gynecomastia surgery) and biopsy services (excisional biopsy for breast cancer and thoracotomy/thoracoscopy for lung cancer) are reviewed by HealthHelp®.
Outpatient echocardiography and percutaneous coronary intervention (coronary angioplasty/stent)
Preauthorization requests for outpatient echocardiography and percutaneous coronary intervention (coronary angioplasty and stent) are reviewed by HealthHelp®.
Effective Dec. 18, 2017, Humana will no longer require PT/OT/ST preauthorization for patients with Humana MA and commercial coverage.
Preauthorization requests for pain management services are reviewed by OrthoNet.
Preauthorization requests for radiation therapy are reviewed by HealthHelp®.