Sleep study

Sleep studies (PSG), facility-based, adult

Preauthorization requests for facility-based sleep studies (polysomnography or PSG) for adults are reviewed by HealthHelp, a nationally recognized benefit management organization.

Note: Home-based sleep studies do not require preauthorization and, in most cases, in-home studies have zero dollar cost-sharing for Humana-covered patients. For more information and ordering information, refer to the Home Sleep Test page. Home sleep testing may not be appropriate in all situations. Humana’s Sleep Studies Medical Coverage Policy is available using Humana’s Medical and Pharmacy Coverage Policies tool (link opens in new window) .

Preauthorization requirement

Preauthorization for PSG is required for all adult 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:

  • Patients with Florida MA health maintenance organization (HMO) or Medicaid HMO
  • Patients with Atlanta MA HMO
  • Patients with Health Care Partners commercial or MA HMO

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 healthcare providers for patients with MA PPO coverage. Notification is requested as this helps coordinate care for your patients.
  • Preauthorization requests for facility-based sleep studies (PSG) for patients with Florida Medicaid coverage should be submitted using the instructions on this page.

Submitting 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

  • 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 preauthorization 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.

General information

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.”

Technical issues

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.

Additional resources

Humana Sleep Studies (PSG) (Facility-Based) Benefit Management (259 KB)(PDF opens in new window)

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

Download PDF

English(PDF opens in new window)

HealthHelp WebConsult online tutorial(PDF opens in new window)

Review the tutorial to learn how to request an authorization, schedule and follow-up on healthcare services.

(2.57 MB) Download PDF

English(PDF opens in new window)