CurrentHumanaPolicy N/A

Preauthorization and Notification Requirements for Indiana Humana Plans

Governs preauthorization and notification processes for Humana Healthy Horizons in Indiana, Indiana PathWays for Aging, and Humana Gold Plus Integrated Indiana LTSS plans; affects providers delivering medical, behavioral health, dental, vision, LTSS and professionally administered medications to enrolled members in Indiana.

Policy Summary

PayerHumana

PolicyPreauthorization and Notification Requirements for Indiana Humana Plans

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionProviders must obtain preauthorization for services and medications listed on the PAL prior to rendering services, except for notifications and urgent/emergent services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

90 daysbasic Medicare benefits exempt

up to 10max procedure codes

up to 6max diagnosis codes

Availity / CoverMyMeds / email / fax / phonerequest channels

Plan applicability and coverage scope

Plan applicability and dual-eligibility notes

Applies to specified Humana Indiana plans; notes on dual-eligible coverage interactions.

This policy governs preauthorization and notification requirements for Humana Healthy Horizons in Indiana, Indiana PathWays for Aging, and Humana Gold Plus Integrated Indiana Long‑Term Services and Supports (LTSS).

Preauthorization is defined as advance approval from the plan determining whether an item or service will be covered; notifications are informational and do not receive approval or denial from Humana.

Dual‑eligibility considerations: For dual plans, Medicaid may cover costs not covered by Medicare. For Indiana PathWays for Aging, Indiana may cover costs not covered by Medicaid or Medicare depending on service type and subgroup.

Authorization code limits and coding constraints

Authorization request code limitsmixed

procedure codes up to 10	Authorization requests may include up to 10 procedure codes
diagnosis codes up to 6	Authorization requests may include up to 6 diagnosis codes

Policy Summary

PayerHumana

PolicyPreauthorization and Notification Requirements for Indiana Humana Plans

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionProviders must obtain preauthorization for services and medications listed on the PAL prior to rendering services, except for notifications and urgent/emergent services.

SourceLink

On This Page

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Preauthorization, notification, and submission channels

Prior Authorization

Obtain preauthorization before providing PAL services; submission channels

Providers must obtain preauthorization for services and medications listed on the PAL prior to rendering services, except for urgent/emergent services which do not require preauthorization. Requests should include member identifiers, service details, and may include up to 10 procedure codes and up to 6 diagnosis codes. Submissions can be made via Availity Essentials, specified Humana intake emails/faxes for Medicaid and duals, or by calling Humana Customer Care/Clinical Intake as listed in the PAL.

Include member name, Medicaid ID, Medicare ID and date of birth, date of service, procedure and diagnosis codes (procedure codes up to 10, diagnosis codes up to 6), service location, provider and facility TIN and NPI, and relevant clinical information.
Submit medical preauthorization via Availity Essentials™ or Humana Clinical Intake (Medicaid: IN_MCD_Intake@humana.com or fax 502-324-6376; Duals: IN_MCD_Duals_Intake@humana.com or fax 502-405-5020).
Behavioral health preauthorization via Humana Clinical Intake (Medicaid: IN_BHMCD_Intake@humana.com or fax 502-508-0447; Duals: IN_BHMCD_Duals_Intake@humana.com or fax 502-508-0408).
For assistance with Availity registration call Availity Client Services at 800-AVAILITY (282-4548).

Note

Notifications are informational only — not approvals

Notifications requested on the PAL are informational only and do not constitute approval or denial; Humana does not issue approval or denial for notifications.

Denial Risk

Consequences of missing preauthorization — financial and benefit risks

Failure to obtain required preauthorization may result in financial penalties for the practice, reduced benefits for the patient, and services provided without preauthorization may be subject to retrospective medical necessity review.

Humana recommends verifying benefits and preauthorization requirements prior to providing services.

Prior Authorization

Submit LTSS preauthorization via INPathWaysLTSSUM@humana.com with member identifiers

LTSS preauthorization requests must be submitted by email to INPathWaysLTSSUM@humana.com and include the member's name, Medicaid ID number, and phone number along with the request.

Prior Authorization

Professionally administered drug authorizations: CoverMyMeds, fax, or phone

Preauthorization requests for professionally administered drugs can be initiated online at CoverMyMeds, by fax to 888-447-3430, or by calling 866-461-7273 (Mon–Fri, 8 a.m.–11 p.m. ET); request forms are available on Humana's prior authorization for professionally administered drugs webpage.

Online: CoverMyMeds®
Fax: 888-447-3430 (use Humana request forms available on the website)
Phone: 866-461-7273, Monday - Friday, 8 a.m. - 11 p.m. Eastern time

Key terms

Preauthorization definition

DefinitionPreauthorization (also known as prior authorization, precertification, preadmission) is the 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.

ScopeApplies to services and medications listed on the Preauthorization and Notification List for Humana Healthy Horizons in Indiana, Indiana PathWays for Aging, and Humana Gold Plus Integrated Indiana LTSS.

ExemptionsUrgent/emergent services do not require preauthorization.

Clinical standardServices must meet Medicare coverage guidelines and be medically necessary per CMS requirements.

Notification definition

DefinitionNotification is the process by which the healthcare provider notifies Humana of the intent to provide an item or service; it is informational and Humana does not issue approval or denial for notifications.

PurposeHelps Humana coordinate member care but is distinguished from preauthorization which requires advance approval.

Effect on coverageA notification does not substitute for preauthorization when preauthorization is required; failure to obtain required preauthorization may result in financial penalties and retrospective review.