Humana Healthy Horizons Prior Auth Policy Update | OpenPayer
CurrentHumanaPolicy N/A
Humana Healthy Horizons in Oklahoma Prior Authorization and Notification List (PAL)
This document lists services, procedures, and codes that require prior authorization or notification for Humana Healthy Horizons® members in Oklahoma and explains how providers should request authorizations and notifications.
Policy Summary
PayerHumana
PolicyHumana Healthy Horizons in Oklahoma Prior Authorization and Notification List (PAL)
Policy CodePolicy N/A
Change TypeNo material changes
Effective DateJan 1, 2026
Next Review DateN/A
Key ActionProviders may request prior authorization through Availity Essentials, by calling 855-223-9868, or by fax at 833-558-9712.
Inpatient notify ≤1 business dayconcurrent review requirement
Jan 1, 2026effective date
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Prior Authorization and Notification Coverage Stance
General PAL coverage stance
Providers must obtain prior authorization or provide notification for services and codes listed on the PAL; failure to comply may result in financial penalties, reduced benefits, or retrospective review.
Providers must follow the PAL and obtain prior authorization or provide notification for codes and services listed on the Humana Healthy Horizons in Oklahoma Prior Authorization and Notification List (PAL).
Urgent/emergent services do not require prior authorization or notification, but inpatient admissions must be notified within one business day and observation services have a 72-hour maximum notification request (observation does not require prior authorization).
Notification is not an approval or denial; it is a provider informing Humana of intent to provide a service to coordinate care.
PAL-listed services and codes
The PAL lists specific CPT/HCPCS and related codes that require prior authorization or notification. Providers should follow the PAL directions for authorization/notification prior to delivering services for listed codes.
Inpatient notification timeframeProviders must submit notification of all inpatient admissions within one business day of the date of admission.
PurposeNotification assists with concurrent review, discharge planning, and coordination of member follow-up care.
Failure to notifyNot obtaining required notification may result in financial penalties and retrospective medical necessity review.
inv-08: Observation period maximum
Maximum observation periodObservation may not exceed three days (72 hours).
Prior authorization for observationPrior authorization is not required for observation, but notification is requested to assist with discharge planning and follow-up.
ImplicationObservation beyond 72 hours would fall outside the stated PAL guidance and may trigger additional review.
How Providers Request Authorization and Notifications
Note
Notification definition and consequence
Notification refers to the process through which a healthcare provider informs Humana of the intent to provide an item or service. Notification is not an approval or denial; it is requested to help coordinate care for Humana-covered patients. Not obtaining required notification or prior authorization may lead to financial penalties for the practice and reduced benefits for the patient; services provided without required prior authorization or notification may be subject to retrospective medical necessity review.
Urgent and emergent services do not require referrals, notifications, or prior authorization. Observation stays do not require prior authorization but notification is requested to assist with discharge planning; observation periods cannot exceed three days (72 hours). For inpatient admissions, providers must submit notification within one business day of the date of admission. Failure to obtain required prior authorization or notification may result in penalties and retrospective review.
Prior Authorization
How to request prior authorization
Except where otherwise noted, prior authorizations for medical and behavioral health services are requested through Availity Essentials. For registration issues call Availity Client Services at 800-AVAILITY (282-4548), Monday–Friday, 8 a.m. – 8 p.m. Eastern. Providers may also call Humana Healthy Horizons in Oklahoma at 855-223-9868 Monday–Friday, 7 a.m. – 7 p.m. Central, or fax requests to 833-558-9712.
Prior Authorization
Vision prior authorization method
Except where otherwise noted, vision prior authorizations are requested through Availity Essentials. For Availity registration assistance call 800-AVAILITY (282-4548), Monday–Friday, 8 a.m. – 8 p.m. Eastern.
Prior Authorization
Prior authorization / PAL-listed codes
The following codes and service categories are listed on the Humana Healthy Horizons in Oklahoma Prior Authorization and Notification List (PAL) and require prior authorization or notification as indicated. This consolidated list groups major categories and representative codes from the PAL. Providers should reference the full PAL for complete code lists and any category-specific notes (for example, therapy age restrictions and Optum notification requirement for Home‑Based Pre‑eclampsia Management).
Durable medical equipment and prosthetics: E2330, E2343, E2351, E2367, E2372, E2373, E2298, E0782, E0785, E0786
Home health / home infusion: 551, 571, T1000, T1004, T1019
Hyperbaric therapy: 99183, G0277
Key Definitions and Policy Terms
inv-16: Prior authorization — Definition
DefinitionPrior authorization (also called precertification or preadmission) is the process a healthcare provider uses to obtain advance plan approval to cover an item or service.
Alternate namesAlso referred to as precertification or preadmission in this PAL.
PurposeObtains plan determination before services are provided to confirm coverage and coordinate care.
inv-17: Notification — Definition
DefinitionNotification is the process by which a provider informs Humana of the intent to provide an item or service.
Not an authorization decisionUnlike prior authorization, Humana does not issue an approval or denial related to a notification.
PurposeHumana requests notification to help coordinate care for Humana-covered patients (e.g., discharge planning, follow-up).
Applies to Home-Based Pre-eclampsia ManagementHome-Based Pre-eclampsia Management services (examples include 99601, 99602, S9140, S9145, S9211, S9213, S9214, S9231, S9351, S9353, S9374, S9375, S9376, S9377, S9379) require notification for Optum.
Action requiredProviders should submit notification per PAL guidance prior to delivery of these Home-Based Pre-eclampsia Management services when managed by Optum.
ReferenceThese codes are explicitly listed in the PAL under Home-Based Pre-eclampsia Management with the note 'Notification Required for Optum.'
Oklahoma Healthcare Authority therapy restrictionPer the Oklahoma Healthcare Authority, CPT codes 97110 and 97530 are for adults only through the alternative to pain management benefit.
Age-based limitation for other therapy codesAll other listed therapy CPT codes are restricted to enrollees under 21 years of age.
Example therapy CPT codes listedExamples listed in the PAL include 92507, 92508, 97110, 97112, 97113, 97116, 97140, 97530, 97533, 97535, 97755, 97761.
Policy Summary
PayerHumana
PolicyHumana Healthy Horizons in Oklahoma Prior Authorization and Notification List (PAL)
Policy CodePolicy N/A
Change TypeNo material changes
Effective DateJan 1, 2026
Next Review DateN/A
Key ActionProviders may request prior authorization through Availity Essentials, by calling 855-223-9868, or by fax at 833-558-9712.
Therapy services (occupational, physical, speech): CPT codes include 92507, 92508, 97110, 97112, 97113, 97116, 97140, 97530, 97533, 97535, 97755, 97761 — note: per Oklahoma Healthcare Authority, CPT codes 97110 and 97530 are adult‑only through the alternative to pain management benefit; all other therapy CPT codes are restricted to enrollees under 21.