Humana – Updates to Preauthorization Requirements for Therapy Services

February 2018 ~

Humana has removed preauthorization requirements for certain therapy services for patients with commercial and Medicare Advantage (MA) coverage.

In December, the insurer issued a notice stating it would longer requires preauthorization for outpatient physical, speech and occupational therapy services for patients with commercial and MA coverage.

This month, Humana posted the following details applicable to this preauthorization 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.
• As with all covered services, therapy services must still meet medical necessity guidelines.
  • For patients with Medicare coverage, CMS coverage guidelines can be found on the Medicare Coverage Database.
  • For patients with commercial coverage, Humana’s Medical Coverage Policies can be found the Medical and Pharmacy Coverage Policies page.

Physicians and other health care professionals may be asked to submit medical records to substantiate the medical necessity of services that have been provided.

Source(s):Humana’s YourPractice;