Behaviour

Behavioral health services

Preauthorization requests for behavioral health and substance use services for Humana commercial and Medicare members are managed by Humana Behavioral Health, a wholly owned Humana subsidiary. Please note: For Medicare Advantage private fee-for-service (MA PFFS) members and for services provided by nonparticipating health care providers for MA PPO members, preauthorization is not required. Notification is requested for these plans, but not required, as this helps coordinate care for our members.

The information on this web page does not apply to your Humana-covered patients in Puerto Rico.

The following services require preauthorization through Humana Behavioral Health:

  • Inpatient hospitalization
  • Partial hospitalization
  • Residential treatment
  • Electroconvulsive therapy (ECT)
  • Transcranial magnetic stimulation (TMS)

Administrative-services-only (ASO) clients may purchase a behavioral health services product, such as managed behavioral health or integrated medical and behavioral health, which includes management of preauthorization through Humana Behavioral Health. For ASO clients with outsourced behavioral health management or those who have purchased a network access-only product, no utilization or case management services are provided by Humana or its clinical affiliates.

Please refer to the member's ID card for appropriate routing of claims or preauthorization inquiries regarding behavioral health services.

Submitting preauthorization requests

Save time: Request patient preauthorizations online

Behavioral health services preauthorizations may be submitted via the Availity Provider Portal:

  1. If you are not registered for the portal, go to Availity.com (link opens in new window) to sign up.
  2. On Availity.com, sign in with your user ID and password.
  3. From the “Patient Registration” drop-down menu, select the “Authorizations and Referrals” option.

Note: When prompted for the Payer, select “Humana Behavioral Health.”

Submit preauthorizations by phone

Preauthorizations for all levels of care may also be submitted by calling the number on the back of the patient's ID card. Select "mental health" when prompted.

Please note: All requests for preauthorization of residential treatment, eating disorders, ECT and TMS require telephonic review.

Submit state-specific inpatient preauthorization requests by fax

The following forms may be used for preauthorization requests in specific states:

Texas preauthorization request form (145 KB) (pdf opens in new window)

Physicians, clinicians and other health care providers in Texas may use this form to submit preauthorization requests for their patients with Humana Behavioral Health coverage. (You may wish to review these instructions(pdf opens in new window). Once complete, please fax it to Humana Behavioral Health at 1-800-807-1898. Include supporting clinical documentation (e.g., medical records, progress notes, assessments, lab reports, etc.) with your fax form.

Indiana preauthorization request form (761 KB) (pdf opens in new window)

Physicians, clinicians and other health care providers in Indiana may use this form to submit inpatient preauthorization requests for their patients with Humana Behavioral Health coverage. Instructions are included on the form. Once complete, please fax it to Humana Behavioral Health at 1-800-807-1898. Include supporting clinical documentation (e.g., medical records, progress notes, assessments, lab reports, etc.) with your fax form.

Florida preauthorization request form (173 KB) (pdf opens in new window)

Physicians, clinicians and other health care providers in Florida may use this form to submit preauthorization requests for their patients with Humana Behavioral Health coverage. Instructions are included on the form. Once complete, please fax it to Humana Behavioral Health at 1-800-807-1898. Include supporting clinical documentation (e.g., medical records, progress notes, assessments, lab reports, etc.) with your fax form.

Medical necessity criteria

If you received a denial letter pertaining to your recent authorization request and the criteria cited in your letter was MCG, you may wish to review the online MCG criteria(link opens in new window)> (registration required) that were used to determine behavioral health medical necessity in your authorization request.

Questions

Questions about preauthorization for behavioral health services may be directed to Humana's commercial customer service line at 1-800-448-6262 or the Medicare customer service line at 1-800-457-4708. Assistance is available Monday through Friday from 8 a.m. to 8 p.m. Eastern time.