CurrentHumanaPolicy N/A

Humana Healthy Horizons in Louisiana Prior Authorization and Notification List

Governs prior authorization (PA) and notification requirements for services and medications for Humana Healthy Horizons members in Louisiana, affecting providers who bill Humana Healthy Horizons in Louisiana Medicaid product.

Policy Summary

PayerHumana

PolicyHumana Healthy Horizons in Louisiana Prior Authorization and Notification List

Policy CodePolicy N/A

Change TypeNo material change

Effective Date01/01/2026

Next Review DateN/A

Key ActionInitiate prior authorization requests for medications via CoverMyMeds (preferred), fax 1-888-447-3430, or call 1-866-461-7273 during business hours.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

01/01/2026effective date

05/27/2026revision date

Humana Healthy Horizons LAproduct covered

HCPCS/NDC requiredHCPCS/NDC requirement

20+drug entries shown

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Coverage overview

General coverage stance and applicability

ALL of the following

This prior authorization and notification list (PAL) identifies services and medications commonly reviewed and that may require prior authorization (PA) or notification for Humana Healthy Horizons in Louisiana members.
The PAL applies only to Humana Healthy Horizons in Louisiana (a Medicaid product of Humana Health Benefit Plan of Louisiana, Inc.) and does not apply to Humana Medicare or other state Medicaid plans.
Certain services outlined in the Medicaid PAL may not be applicable for practitioners affiliated with an independent practice association via a capitated or delegated arrangement; providers should refer to their provider agreement for clarification.
Services or medications provided without a PA may be subject to retrospective medical necessity review; providers should verify benefits and PA requirements with Humana prior to providing services.

Emergent services

ALL of the following

Emergent services do not require a referral or prior authorization (PA).
Absence of authorization and/or notification prior to the date of service could result in financial penalties for the practice and reduced benefits for the member, based on the provider's contract and the member's Evidence of Coverage.

Prior authorization / notification stance (partial)

This partial list identifies medications that are on the Humana Healthy Horizons in Louisiana prior authorization and notification list; many items require prior authorization or notification and some require NDC billing when using shared HCPCS/NOC codes.

ALL of the following

The document provides a partial extract of drug entries that are subject to prior authorization or notification under Humana Healthy Horizons in Louisiana (examples include J1744, J1572, J7320, J0223, J0257, J1447, and many others).
Entries marked with special notations in the listing indicate additional handling: † denotes new-to-market drug additions; †† denotes items for which preauthorization requests are routed to the Humana National Transplant Network.
All shared HCPCS codes and not‑otherwise‑classified codes require a corresponding National Drug Code (NDC) to be billed on all claims when those codes are used (see listing for entries using C9399, J3490, J3590, etc.).

Prior authorization/notification listing guidance

This partial listing identifies drugs that require prior authorization or notification; billing guidance and special handling noted.

ALL of the following

Drugs in the listing are shown with brand name, generic name, and associated HCPCS/J‑codes where applicable (examples in the extract include J1203, J9295, J9204, J9307, C9399 and others).
Shared HCPCS and not‑otherwise‑classified codes (eg, C9399, J3490, J3590) require a corresponding NDC to be billed on all claims for those items.
Preauthorization requests for transplant‑related items (notations ††) are reviewed by the Humana National Transplant Network; submission methods and contact details are provided in the listing.
Fax forms are referenced as the mechanism to request prior authorization or to provide notification; providers should use the referenced forms and submission channels.

Billing, codes, and mapping guidance

Examples of HCPCS mappings for listed medicationsHCPCS

Q2055	Abecma (idecabtagene vicleucel) — HCPCS listed in table
J9264	Abraxane (paclitaxel-nab) — HCPCS listed in table

Notable billing notesHCPCS

J9035

Bevacizumab (Avastin) — auth only required for Oncology/Chemo use

Sample HCPCS mappings (partial)HCPCS

J1744	Flebogamma DIF (immune globulin) — listed mapping
J1572	Flebogamma DIF alternate code

sample drug-to-code mappings in listHCPCS

J1203	cipaglucosidase alfa-atga (Pombiliti)
J9295	necitumumab (Portrazza)
J9204	mogamulizumab-kpkc (Poteligeo)
J9307	pralatrexate (pralatrexate IV)
C9399	not otherwise classified HCPCS (used for multiple listed drugs)

NDC requirement for shared HCPCS codes

RequirementAll shared Healthcare Common Procedure Coding System (HCPCS) codes and not otherwise classified codes require a corresponding National Drug Code (NDC) to be billed on all claims.

Applies toShared HCPCS entries and NOC codes in the Humana Healthy Horizons in Louisiana PAL (examples shown throughout listing).

PurposeEnsures specific drug product identification when multiple products map to the same HCPCS/NOC code.

Claiming noteInclude the appropriate NDC on professional and facility claims when billing shared HCPCS or C9399/J3490/J3590 entries.

How providers submit requests and required actions

Prior Authorization

Prior authorization and notification overview

Prior authorization (PA) is required for certain services and medications listed on the Humana Healthy Horizons in Louisiana Prior Authorization and Notification List. Emergent services do not require PA. 'Notification' is distinct from PA — notification lets Humana know the provider intends to deliver a service but is not an approval or denial. Services or medications provided without a required PA may be subject to retrospective medical necessity review and could result in financial penalties for the practice or reduced member benefits per the provider's contract and the member's Evidence of Coverage.

Emergent services do not require a referral or PA.
Notification is not an approval or denial; it is for care coordination.
Absence of required authorization/notification may lead to financial penalties or reduced benefits.

Note

How to submit PA requests for medications

Medication PA requests may be submitted using Humana's preferred vendor or via fax or phone. Use CoverMyMeds (preferred) for faster processing when available. Fax requests and phone support are available for professionally administered drugs.

Preferred: CoverMyMeds
Fax: 1-888-447-3430 (forms available at Humana's prior authorization for professionally administered drugs website)
Phone: 1-866-461-7273, Monday ─ Friday, 8 a.m. ─ 11 p.m.

Note

Transplant preauthorization routing

Transplant preauthorization requests are routed to and reviewed by the Humana National Transplant Network. Providers should submit transplant-related preauthorization requests via the network's fax, phone, or email contact methods.

Fax: 502-508-9300
Phone: 866-421-5663, Monday ─ Friday, 7 a.m. ─ 7 p.m., Central time
Email: transplant@humana.com

Denial Risk

Consequences of missing authorization/notification

Failure to obtain required prior authorization or provide requested notification prior to the date of service may result in financial penalties for the practice and reduced benefits for the member, consistent with the provider's contract and the member's Evidence of Coverage. Services provided without PA may be subject to retrospective medical necessity review.

Potential financial penalties or reduced member benefits if authorization/notification is missing
Retrospective medical necessity review may apply for services provided without PA

Prior Authorization

Preauthorization submission instructions (transplant-related)

Preauthorization requests for transplant-related services are reviewed by the Humana National Transplant Network. Use the Network's fax, phone, or email to submit requests and supporting clinical information.

Fax transplant preauthorization to 502-508-9300
Call 866-421-5663, Monday ─ Friday, 7 a.m. ─ 7 p.m., Central time
Email transplant@humana.com

Note

General prior authorization/notification forms

Access Humana's prior authorization fax forms to request prior authorization or to provide notification for services and medications. The fax forms include submission templates for professionally administered drugs and other services that require PA or notification.

Access the fax forms to request prior authorization or provide notification (available on Humana's provider resources)
Use the appropriate fax form for professionally administered drugs when faxing PA requests
Ensure required supporting clinical documentation accompanies faxed requests to avoid delays

Prior Authorization

Transplant preauthorization submission

Preauthorization requests for transplants — reviewed by Humana National Transplant Network — can also be submitted by fax or phone; see transplant contact details listed previously.

Fax: 502-508-9300
Phone: 866-421-5663
Email: transplant@humana.com

Note

General prior authorization/notification forms (alternate listing)

Alternate access to Humana's fax forms is available throughout the prior authorization and notification list document. Providers should use the fax forms appropriate to the service or medication being requested, and follow any code billing requirements noted (for example, HCPCS codes requiring an associated NDC).

Access the fax forms to request prior authorization or provide notification (alternate listing)
All shared HCPCS and not otherwise classified codes require a corresponding NDC to be billed on claims where noted

Key terms and notation

Prior authorization — definition of PA process

DefinitionPrior authorization (PA) is a process through which the healthcare provider is required to obtain advance approval from the plan as to whether an item or service will be covered.

When requiredPA is required for certain services and medications listed in the prior authorization and notification list; emergent services do not require PA.

ConsequenceServices or medications provided without a PA may be subject to retrospective medical necessity review; verify benefits and PA requirements prior to providing services.

Also known asPrecertification or preauthorization (terms used interchangeably).

Notification — definition of notification process

DefinitionNotification is the process when the healthcare provider notifies Humana of the intent to provide an item or service; Humana requests notification to help coordinate care.

Distinct from PAHumana does not issue an approval or denial related to a notification; it is not a substitute for PA when PA is required.

Use caseProviders must notify Humana for items/services identified on the PAL that require notification rather than approval.

Shared HCPCS / C9399 / J3490 / J3590 — NDC billing requirement

Policy statementShared HCPCS and not otherwise classified (NOC) codes (e.g., C9399, J3490, J3590) require a corresponding National Drug Code (NDC) to be billed on all claims.

Examples in listEntries flagged with ‡ in the PAL (for example Prevymis IV, Qivigy, Zycubo) indicate use of shared HCPCS/C9399 or J3490/J3590 codes that require NDC reporting.

Billing implicationWhen multiple products map to the same HCPCS/NOC code, include the exact NDC to identify the billed product on professional and facility claims.

Special notation legend

†Denotes new-to-market drug addition.

‡Indicates entries where all shared HCPCS and not otherwise classified codes require a corresponding NDC to be billed on all claims.

††Indicates preauthorization requests routed to the Humana National Transplant Network (transplant fax/phone/email provided in the PAL).

OpenPayer

Humana Healthy Horizons in Louisiana Prior Authorization and Notification List

Coverage criteria and listing overview

Billing, codes, and mapping guidance

How providers submit requests and required actions

Key terms and notation