CurrentHumanaPolicy N/A

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

Governs prior authorization and notification requirements for medical, behavioral health services and provider-administered medications for Humana Healthy Horizons members in Louisiana; affects participating providers and delegated entities.

Policy Summary

PayerHumana

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

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization via Availity, phone, fax, or specified vendor (CoverMyMeds) before providing items or services listed on the PAL.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3access methods described

1state-specific PAL (LA)

24/7-ishtelephone hours noted

Prior Authorization and Notification Requirements

Providers must follow the linked PAL to determine which services and provider‑administered medications require prior authorization or notification. Emergent services are exempt.

Check the linked 2025 Louisiana Medicaid PAL for listed medical/behavioral health services and provider‑administered medications that commonly require prior authorization or notification.

Links to full PALs are provided on the Humana PAL page.

Verify member benefits and whether prior authorization is required prior to providing services; services or medications provided without required prior authorization may be subject to retrospective medical necessity review and potential financial penalties.

Confirm member coverage via the patient’s Certificate of Coverage or contact Humana.

Notification is a distinct process from prior authorization: notification informs Humana of intent to provide an item or service but does not constitute approval or denial.

Policy Summary

PayerHumana

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

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization via Availity, phone, fax, or specified vendor (CoverMyMeds) before providing items or services listed on the PAL.

SourceLink

On This Page

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Provider Requirements and Submission Methods

Prior Authorization

Obtain prior authorization before providing PAL-listed services; notification is not approval

Providers must obtain prior authorization (precertification, preadmission) from Humana for items or services listed on the PAL before delivering care. Notification is a separate process in which the provider informs Humana of the intent to provide an item or service; Humana does not issue an approval or denial for notifications.

Documentation Required

How to submit prior authorization requests

Submit prior authorization requests for medical services via Availity Essentials (online), by calling Humana Healthy Horizons in Louisiana, or by faxing the prior authorization form; behavioral health requests via the Behavioral Health Crisis Line; medication requests via CoverMyMeds, fax, or phone.

Medical: Availity Essentials (online), phone 1-800-448-3810 (Mon–Fri, 7 a.m.–7 p.m.), or fax 1-833-974-0059
Behavioral health: Behavioral Health Crisis Line 1-844-461-2848
Medications: CoverMyMeds (www.CoverMyMeds.com), fax 888-447-3430, or phone 866-461-7273 (Mon–Fri, 8 a.m.–11 p.m. ET)

Denial Risk

Emergent services exempt from prior authorization; lack of authorization may trigger review or penalties

Emergent services do not require prior authorization; however, services provided without prior authorization or notification may be subject to retrospective medical necessity review and could result in financial penalties or reduced member benefits.

Emergent services: no referral or prior authorization required
Absence of authorization/notification may lead to financial penalties for the practice and reduced member benefits
Services provided without prior authorization may be retrospectively reviewed for medical necessity

Key Terms

Prior authorization (precertification, preadmission)

DefinitionPrior authorization (also known as precertification and preadmission) is a process requiring the physician or other healthcare provider to obtain advance approval from the plan as to whether an item or service will be covered.

When requiredProviders must follow the linked PAL to determine which services and medications require prior authorization before delivering non-emergent care.

Relation to emergent careEmergent services do not require prior authorization; refer to PAL for non-emergent requirements.

Notification

DefinitionNotification is the process of the physician or other healthcare provider notifying Humana of the intent to provide an item or service; it is distinct from prior authorization.

Effect on coverage decisionHumana does not issue an approval or denial related to a notification; notification is for care coordination purposes.

Provider actionProviders should submit notifications as required by the PAL to ensure coordination of care for Humana-covered patients.

Investigational / Experimental procedures

Typical coverage stanceInvestigational and experimental procedures usually are not covered benefits under the plan.

Confirmation stepConfirm coverage by consulting the member's Certificate of Coverage or contacting Humana for case-specific determination.

Action for providersDo not rely on the PAL alone for investigational items—verify benefit and coverage exceptions with Humana before providing services.

OpenPayer

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

Prior Authorization and Notification Requirements

Linked PAL and Coding Details

Provider Requirements and Submission Methods

Key Terms