Humana Updates Preauthorization Requirements for Therapy Services
Humana will no longer require preauthorization for outpatient physical, speech and occupational therapy services for patients with commercial and Medicare Advantage (MA) coverage, effective Dec. 18, 2017. Following are some important details about this change:
- While preauthorization will no longer be required, visit limits and other plan provisions (e.g., referrals) will still apply.
- Referrals should be submitted to Humana via Availity.com (registration required) for prompt processing.
- As with all covered services, therapy services must still meet medical necessity guidelines. For patients with Medicare coverage, CMS coverage guidelines can be found at https://www.cms.gov/medicare-coverage-database/ (link opens in new window). For patients with commercial coverage, Humana’s Medical Coverage Policies can be found at http://apps.humana.com/tad/tad_new/home.aspx?type=provider (link opens in new window).
- Physicians and other health care professionals may be asked to submit medical records to substantiate the medical necessity of services that have been provided.
- For additional information, contact Humana using the telephone number listed on the patient’s member ID card.