Outpatients Procedure

Outpatient echocardiography and percutaneous coronary intervention (angioplasty/stent)

Preauthorization requests for transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), stress echocardiography and percutaneous coronary intervention (PCI, angioplasty/stent) are reviewed by HealthHelp®, a nationally recognized benefit management organization.

Preauthorization requirement

Preauthorization for TTE, TEE, stress echocardiography and percutaneous coronary intervention (PCI, angioplasty/stent) is required for all patients with Humana commercial coverage and most patients with Humana Medicare Advantage and dual Medicare-Medicaid coverage, unless otherwise noted below.

HealthHelp does not review preauthorization requests for the following, as physicians and other health care 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:

  • Patients with Florida MA health maintenance organization (HMO) and Medicaid HMO
  • Patients with Atlanta MA HMO (primary care physician referral required)
  • Patients with Ochsner commercial and MA HMO
  • Patients with Health Care Partners commercial and MA HMO
  • Chicago risk and delegated physicians/providers

Please note:

  • For patients with MA Private Fee-for-Service (PFFS) coverage, preauthorization is not required. Notification is requested for these plans, as this helps coordinate care for your patients.
  • Preauthorization is not required for services provided by nonparticipating health care providers for pateints with MA PPO coverage. Notification is requested as this helps coordinate care for your patients.

Submitting preauthorization requests

Preauthorization requests for TTE, TEE, stress echocardiography and percutaneous coronary intervention (PCI, angioplasty/stent) ordered for a Humana-covered patient are reviewed by HealthHelp.

Submitting a request online

Physicians and other health care providers may submit a request to Consult, HealthHelp's online program(link opens in new window).

Submitting a request by phone

Phone: 1-866-825-1550 Monday – Friday from 7 a.m. to 7 p.m. Central time Saturday from 7 a.m. to 4 p.m.

Urgent/expedited requests: All urgent/expedited requests should be submitted via phone to 1-866-825-1550.

For patients in Puerto Rico

  • For Puerto Rico patients with commercial coverage, submit preauthorization requests by telephone at 1-800-611-1474, or by fax to 1-800-658-9457.
  • For Puerto Rico patients with MA coverage, submit preauthorization requests by telephone at 1-866-488-5995 or 1-866-773-5959, or by fax to 1-800-594-5309.

State-specific preauthorization forms

While HealthHelp recommends submission of preauthorization requests online or via telephone, the following forms may be used for authorization requests in specific states:

Texas preauthorization request form (438 Kb)

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.

Indiana preauthorization request form (760 Kb)

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.

Additional resources

Humana Cardiology Benefit Management

Learn more about this program and the patient information required when requesting preauthorization.

(258 KB) Download PDF

English(PDF opens in new window)

Consult Online tutorial

Learn how to request, schedule and follow up on imaging services and treatment plans for your Humana-insured patients online with Consult Online by reviewing this tutorial.

(2.57 MB) Download PDF

English(PDF opens in new window)

Questions

Questions about preauthorization for TTE, TEE, stress echocardiography and percutaneous coronary intervention (PCI, angioplasty/stent) may be directed to HealthHelp's Consult program support team at 1-800-546-7092. Assistance is available Monday through Friday from 7 a.m. to 7 p.m. Central time.

Email: rcsupport@healthhelp.com