CurrentHumanaPolicy N/A

Humana Healthy Horizons in Indiana — Prior Authorization and Notification List for Provider‑Administered Medications

Governs prior authorization and notification requirements and submission methods for provider-administered medications for Humana Healthy Horizons in Indiana members (Medicaid product). Affects providers administering medications in-office, clinic, outpatient or home settings.

Policy Summary

PayerHumana

PolicyPrior Authorization and Notification List for Provider‑Administered Medications (Humana Healthy Horizons in Indiana)

Policy CodePolicy N/A

Change TypeAdministrative — no material clinical changes

Effective Date01/01/2026

Next Review DateN/A

Key ActionSubmit prior authorization requests online (CoverMyMeds), by fax to 888-447-3430, or by phone at 866-461-7273 (TTY 711).

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

01/01/2026Effective date

05/27/2026Last review

Fax, phone, onlineRequest methods

Healthy Horizons INProduct / jurisdiction

Coverage and Prior Authorization Requirements

Administrative coverage criteria

General coverage stance and administrative rules

Applies to Humana Healthy Horizons in Indiana (Medicaid product) for provider-administered medications delivered in office, clinic, outpatient, or home settings.

Authorization is not a guarantee of payment; services or medications provided without prior authorization may be subject to retrospective medical necessity review and could result in financial penalties based on provider contract and member Evidence of Coverage.

Emergent services do not require prior authorization.

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

Certain transplant-related preauthorization requests are reviewed by the Humana National Transplant Network and follow separate routing instructions.

All shared HCPCS and not otherwise classified (NOC) codes require a corresponding National Drug Code (NDC) to be billed on all claims.

Medication list is an extensive alphabetical listing of provider-administered medications with associated generic names and HCPCS/CPT/Q-codes; some entries are marked as new-to-market (†) or as requiring transplant review (††).

Prior Authorization / Notification List (excerpt)

List of provider-administered medications requiring prior authorization or notification for Humana Healthy Horizons in Indiana, with associated HCPCS/Q-codes and notations.

The document lists numerous provider-administered medications (alphabetical) that commonly require prior authorization or notification; each entry includes brand name, generic name, and code(s).

Notation legend used in the list: † = new-to-market drug addition; ‡ = shared HCPCS/NOC codes require corresponding NDC on claims; †† = items reviewed by the Humana National Transplant Network.

Providers should access referenced fax forms to submit prior authorization requests or provide notifications as indicated in the list entries.

Provider-administered medication PA list (partial)

Listed brand/generic medication names with associated codes indicate inclusion on the prior authorization/notification list for provider-administered medications.

Example entries (partial, illustrative): Vimizim = elosulfase alfa (J1322); Vyepti = eptinezumab-jjmr (J3032); Xembify = immune globulin (J1558).

Additional examples (partial): Uptravi ‡ = selexipag (C9399, J3490); Velcade ‡ = bortezomib (J9041); Ziextenzo = pegfilgrastim-bmez (Q5120).

Gene-therapy and transplant-related examples marked for transplant review: Zynteglo †† = betibeglogene autotemcel (J3393).

Submission, Routing, and Provider Requirements

Prior Authorization

Prior authorization and notification overview

Prior authorization (precertification) is required for many provider‑administered medications; notification is requested for some services to coordinate care for Indiana PathWays for Aging members. Emergent services do not require prior authorization, and providers may request urgent prior authorization when delay would be detrimental. Authorization is not a guarantee of payment; absence of prior authorization/notification may result in financial penalties or retrospective review.

Emergent services do not require a referral or prior authorization.
Urgent prior authorization may be requested when delay would be detrimental.

Prior Authorization

Submission methods for prior authorization

Prior authorization requests may be submitted online (preferred) via CoverMyMeds, by fax to 888-447-3430, or by phone to 866-461-7273 (TTY 711). Phone support is available Monday–Friday, 8 a.m.–11 p.m. Eastern time.

Online (preferred): CoverMyMeds website
Fax: 888-447-3430
Phone: 866-461-7273 (TTY 711)

Prior Authorization

Transplant preauthorization routing

Preauthorization requests for transplant-related items are reviewed by the Humana National Transplant Network and should be routed to that team for review.

Humana National Transplant Network reviews transplant-related preauthorization requests

Prior Authorization

How to submit prior authorization requests

Preauthorization requests can be submitted by fax, phone, or email when directed; transplant-related requests will be routed to and reviewed by the Humana National Transplant Network, which accepts fax, phone, or email submissions.

When directed, submit PA by fax, phone, or email.
Transplant requests: fax 502-508-9300, phone 866-421-5663, email transplant@humana.com (Mon–Fri 7 a.m.–7 p.m. CT).

Documentation Required

Submission forms (fax request forms)

Access Humana's fax forms to request prior authorization or to provide required notifications; forms are referenced on Humana's prior authorization for professionally administered drugs resources.

Fax request forms available on Humana's prior authorization for professionally administered drugs web pages.

Prior Authorization

Transplant preauthorization submission contacts

Preauthorization requests for transplant-related items will be reviewed by the Humana National Transplant Network and can be submitted by fax to 502-508-9300, by phone at 866-421-5663 (Monday–Friday, 7 a.m.–7 p.m. Central time), or by email to transplant@humana.com.

Fax: 502-508-9300
Phone: 866-421-5663 (Mon–Fri 7 a.m.–7 p.m. CT)
Email: transplant@humana.com

Documentation Required

PA request forms (access fax forms)

Access the fax forms referenced in the document to request prior authorization or to provide notification; forms are available via the Humana provider resources cited in the PA guidance.

Use the referenced fax forms to submit PA requests or notifications.

Definitions and Billing Notes

Prior authorization — definition

DefinitionPrior authorization (also known as precertification or preauthorization) is the process by which a healthcare provider obtains advance approval from the plan to determine whether an item or service may be covered.

Also calledPrecertification; preauthorization.

PurposeEnsures review of provider‑administered medications that commonly require additional clinical information prior to coverage.

Notification — definition

DefinitionNotification is the process by which a healthcare provider notifies Humana Healthy Horizons of Indiana of its intent to provide an item or service; Humana does not issue an approval or denial for notifications.

PurposeUsed to help coordinate care for Indiana PathWays for Aging members and differs from prior authorization.

Effect on coverageNotification is not a substitute for prior authorization when authorization is required; it does not guarantee payment.

Billing NDC requirement for shared HCPCS/NOTC codes

RequirementAll shared HCPCS and not‑otherwise‑classified (NOC) codes require a corresponding National Drug Code (NDC) to be billed on all claims.

ScopeApplies to shared HCPCS (including C‑, J‑, Q‑, and other miscellaneous codes) and NOC codes listed in the provider‑administered medication list.

ReasonEnsures accurate identification of the specific drug product when codes represent multiple products or new‑to‑market items.

Transplant preauthorization routing

RoutingPreauthorization requests for transplant‑related items will be reviewed by the Humana National Transplant Network.

Fax contactFax: 502‑508‑9300.

Phone contactPhone: 866‑421‑5663 (Monday–Friday, 7 a.m.–7 p.m. Central time).

Email contactEmail: transplant@humana.com.

New‑to‑market indicator

Symbol† indicates a new‑to‑market drug addition included on the list.

ContextUsed in the medication list to flag products newly introduced to the market.

Action for providersRefer to the list notation when submitting authorization requests to ensure correct handling of new products.

HCPCS/NOC billing requirement

Billing requirementAll shared HCPCS codes and not‑otherwise‑classified (NOC) codes require a corresponding NDC to be billed on all claims.

Applies toC‑, J‑, Q‑ and miscellaneous codes that may represent multiple products or joinder codes in the medication list.

DocumentationInclude the specific NDC on claim submissions to avoid claim denials or billing issues.

Symbol legend

†Indicates new‑to‑market drug addition.

††Indicates items that will be reviewed by the Humana National Transplant Network; special routing instructions apply (fax, phone, email).

‡Denotes that all shared HCPCS and NOC codes require a corresponding NDC to be billed on all claims.

J9264	Abraxane (paclitaxel-nab) HCPCS
J3262	Actemra IV (tocilizumab)
J9042	Adcetris (brentuximab vedotin)

C9399, J3490, J3590	Common 'not otherwise classified' HCPCS and miscellaneous J-codes used for certain new-to-market or gene therapies (examples shown throughout list)
Q-codes, J-codes	Various Q- and J- HCPCS codes listed per medication (document lists specific code per brand)

OpenPayer

Humana Healthy Horizons in Indiana — Prior Authorization and Notification List for Provider‑Administered Medications

Coverage and Prior Authorization Requirements

HCPCS / J-Code and Other Code Mappings

Submission, Routing, and Provider Requirements

Definitions and Billing Notes

J1322	Vimizim (elosulfase alfa) HCPCS example
J1558	Xembify (immune globulin) example
J3032	Vyepti (eptinezumab-jjmr) example