Preauthorization requests for the following procedures are reviewed by HealthHelp®, a nationally recognized benefit management organization:
Preauthorization for diagnostic/cardiac imaging is required for all patients with Humana commercial coverage and most patients with Humana Medicare and dual Medicare-Medicaid coverage, unless otherwise noted below.
HealthHelp does not review preauthorization requests for the following, as physicians and other healthcare providers who participate in an independent practice association (IPA) or other risk network with delegated services need to refer to their IPA or risk network for guidance on processing preauthorization requests:
Preauthorization requests for services managed by HealthHelp may be submitted via:
For questions, contact HealthHelp at 1-866-825-1550.
For patients in Puerto Rico
While HealthHelp recommends submission of preauthorization requests online or via telephone, the following forms may be used for preauthorization requests in specific states:
Physicians and other clinicians in Texas may use this form to submit preauthorization requests for their Humana-covered patients. Instructions are available here (127 Kb). Once complete, please fax it to HealthHelp at 1-888-863-4464. Include supporting clinical documentation (e.g., medical records, progress notes, lab reports, radiology studies, etc.) with your fax form.
Physicians and other clinicians in Indiana may use this form to submit preauthorization requests for their Humana-covered patients. Instructions are included on the form. Once complete, please fax it to HealthHelp at 1-888-863-4464. Include supporting clinical documentation (e.g., medical records, progress notes, lab reports, radiology studies, etc.) with your fax form.
The HealthHelp managed procedure code list and other general information is available at www.healthhelp.com/humana (link opens in new window). Under “Consult,” select “Learn More.”
Physicians can consult with HealthHelp's experts in diagnostic imaging (CT, MRI, PET) and radiation therapy/radiotherapy (2D/3D, IMRT, SRS/SBRT) for breast, lung, prostate (includes risk algorithm), colorectal, brain and gynecologic cancers.
For assistance with HealthHelp technical questions (e.g., online access, password reset or updating physician/facility information), contact RCSupport@HealthHelp.com or call 1-800-546-7092, Monday through Friday, 7 a.m. to 7 p.m. Central time.
Learn more about this program and the patient information required when requesting preauthorization.
Review the tutorial to learn how to request an authorization, schedule and follow-up on healthcare services.