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.
- Physicians and other health care professionals may be asked to submit medical records to substantiate the medical necessity of services that have been provided.
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I called Humana to clarify if we need to still request visit dates and the representative told me if it was a PPO no but if it was an HMO we have to call to check! I also asked if the Physician or the Physical therapy office needed to go thru Availity but didn’t receive an answer just call the number on the back of the card! Does anyone have any info on this new rule? or understand?
If visit limits, referrals still apply how do you get visit limits?
You would need to call Humana to obtain the benefit coverage for therapy services.
Rick:
Do you know what Humana plan this is for? My Business Office asked me this question.
Per our Managed Care Partner (Mata) who looks at our contracts states our hospital is only contracted with Humana Choice. Humana has several plans under their name- Humana and our Business Office has Mata working on contracts right now so that they can make sure our hospital is covered with all plans. Let me know.
Thank you,
Marcie Ganson, PT, DPT, MBA
It states commercial and Medicare Advantage (MA) coverage, effective Dec. 18, 2017