Humana Healthy Horizons in Louisiana Prior Authorization and Notification List (PAL)
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Governs prior authorization and notification requirements for services, procedures, durable medical equipment, medications, and behavioral health services for Humana Healthy Horizons Medicaid members in Louisiana; affects participating and nonparticipating providers delivering covered services.
No material clinical or coverage changes in this revision.
Services Requiring Prior Authorization or Notification
Coverage categories with prior authorization/notification requirements
Categories and sample codes included on the PAL (not exhaustive). Providers must obtain prior authorization or provide notification as indicated per category; specific prior authorization rules are noted where present.
ALL of the following
ALL of the following
- Hospital beds: E0260-E0304 (examples)
- Noninvasive home ventilators: E0466
- Orthotics/Prosthetics (examples): L5010-L7045 series
ALL of the following
ALL of the following
- Transplant procedure/testing examples: 32850-33945, 38205-38243, 81370-81383, 0584T-0670T, G0341-G0343
ALL of the following
ALL of the following
ALL of the following
ALL of the following
ALL of the following
ALL of the following
ALL of the following
- PET scan examples: 78608-78609, 78811-78816
Prior authorization and notification requirements (excerpt)
Selected services and procedures listed in the PAL require prior authorization or notification as specified; specific clinical criteria and authorization procedures are defined elsewhere in the full PAL.
Humana expects notification for obstetrical admissions that exceed 48 hours for vaginal deliveries and 96 hours for cesarean sections to allow concurrent review for care coordination and discharge planning.
For crisis intervention, behavioral health crisis care and mobile crisis, Humana expects notification within 48–72 hours for concurrent review and care coordination activities.
Prior authorization is required for initiation of ECT while the member is inpatient only.
Prior authorization is required for CBCS services beyond 16 units; no prior authorization is required for the initial CBCS visit (initial visit is concurrent documentation only).
Relevant CPT/HCPCS and Procedure Codes
How Providers Must Initiate Authorization and Notification
How to initiate prior authorization/notification
Prior authorization requests may be initiated via Availity Essentials (registration required), by calling Humana Healthy Horizons in Louisiana at 1-800-448-3810 Monday through Friday, 7 a.m. to 7 p.m., or by faxing the prior authorization form to 1-833-974-0059. Behavioral health prior authorization may be initiated by calling the Behavioral Health Crisis Line at 1-844-461-2848.
Notification is not prior authorization
Notification is distinct from prior authorization; Humana requests notifications to coordinate care but does not issue an approval or denial when a notification is submitted.
Urgent/emergent service exception
Urgent or emergent services do not require referrals, prior authorization, or notification and should be handled per standard emergency care procedures.
Consequences of not obtaining authorization/notification
Failure to obtain required prior authorization or required notification may lead to financial penalties for the practice, reduced member benefits, and services being subject to retrospective medical necessity review.
Obstetrical admission notification timeframes
Humana Healthy Horizons expects notification for obstetrical admissions that exceed 48 hours for vaginal deliveries and 96 hours for cesarean sections to allow concurrent review for care coordination and discharge planning.
Behavioral health/crisis notification timeframe
For crisis intervention, behavioral health crisis care and mobile crisis, Humana Healthy Horizons expects notification within 48 to 72 hours to permit concurrent review and care coordination activities.
ECT prior authorization (inpatient initiation)
Electroconvulsive therapy (ECT) requires prior authorization when initiated while the member is an inpatient; prior authorization is expected for inpatient initiation only.
Procedure code prior authorization/notification — see PAL
Numerous surgical and procedural codes listed in the PAL require prior authorization or notification as specified; providers must consult the full PAL for the complete list and indication (examples include neurostimulator procedures, obesity surgery, transplant, varicose vein procedures, and ventricular assist devices).
- Consult the full PAL for specific CPT/HCPCS and procedure codes and whether prior authorization or notification is required.
Key Definitions
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