CurrentHumanaPolicy N/A

Humana Healthy Horizons in Oklahoma Prior Authorization and Notification List (PAL)

Governs prior authorization and notification requirements for services and provider‑administered medications for Humana Healthy Horizons members in Oklahoma; affects contracted healthcare providers and facilities delivering medical, behavioral health, vision, and provider‑administered medication services.

Policy Summary

PayerHumana

PolicyHumana Healthy Horizons in Oklahoma Prior Authorization and Notification List (PAL)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionProviders must notify Humana of all inpatient admissions within one business day for concurrent review; prior authorizations are requested via Availity Essentials or the specified phone/fax/covermymeds channels.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

72 hoursobservation limit

1 business dayinpatient notification

Availity / phone / faxauth submission methods

covermymeds / fax / phonemedication auth methods

Coverage and Authorization Rules

High-level coverage stance and operational rules

Emergent services do not require referral or prior authorization.

Observation prior authorization is not required but notification is requested to assist with discharge planning and follow-up; observation cannot exceed 72 hours.

Threshold: 72 hours

Providers must notify Humana of all inpatient admissions within one business day of admission for concurrent review.

A provider may request an urgent prior authorization when a delay would be detrimental to the member's health.

Services or medications provided without prior authorization may be subject to retrospective medical necessity review and potential financial penalties per provider contract and the member's Certificate of Coverage.

Policy Summary

PayerHumana

PolicyHumana Healthy Horizons in Oklahoma Prior Authorization and Notification List (PAL)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Prior Authorization, Notification & Submission Guidance

Note

Prior Authorization and Notification Overview

This PAL describes services and medications that are commonly reviewed and may require additional clinical information; medications include those delivered in the provider's office, clinic, outpatient or home setting. Investigational and experimental procedures usually are not covered benefits.

Denial Risk

Timing, Observation & Inpatient Notification Requirements

Emergent services do not require a referral or prior authorization. Observation does not require prior authorization but Humana requests notification to assist with discharge planning; observation cannot exceed three days (72 hours). Providers must notify Humana of all inpatient admissions within one business day for concurrent review. Failure to obtain required authorizations or notifications may result in financial penalties or retrospective medical necessity review.

Observation period limit: 72 hours (three days).
Inpatient admissions: notify within one business day.
Urgent prior authorization may be requested when delay would be detrimental to the member.

Prior Authorization

How to Submit Prior Authorization Requests

Except where noted, prior authorizations for medical, behavioral health and vision services are requested through Availity Essentials; phone and fax options are available. Prior authorizations for physician‑administered medications can be submitted via covermymeds, fax (888-447-3430), or phone (866-461-7273).

Medical & behavioral health: Availity Essentials; phone 855-223-9868; fax 833-558-9712.
Vision: Availity Essentials.
Physician‑administered meds: covermymeds, fax 888-447-3430, or phone 866-461-7273 (Mon–Fri, 8 a.m.–11 p.m. ET).

Key Definitions

Prior authorization

DefinitionProcess a healthcare provider uses to obtain advance plan approval to cover an item or service

OutcomeResults in an approval or denial from the plan (contrast to notification)

Also referred to asPrecertification or preadmission

Notification

DefinitionProcess through which a healthcare provider informs Humana of the intent to provide an item or service; does not result in an approval or denial

PurposeRequested to help coordinate care for Humana-covered patients

DistinctionNotification does not substitute for prior authorization when prior authorization is required

Investigational / experimental procedures

Investigational/experimental proceduresProcedures that are usually not covered benefits

ActionContact Humana for confirmation of coverage

Policy noteThese procedures are listed as typically not covered in the PAL

ImplicationMay require case-by-case review if coverage is uncertain

OpenPayer

Humana Healthy Horizons in Oklahoma Prior Authorization and Notification List (PAL)

Coverage and Authorization Rules

Referenced Codes and Observation Limits

Prior Authorization, Notification & Submission Guidance

Key Definitions