Commercial Preauthorization and Notification List - How to request and emergency guidance

Sep 17, 2026

Commercial Preauthorization and Notification List outlines how Humana manages coverage decisions for certain medical services and medications for all commercial fully insured plans. It defines preauthorization versus notification, explains when emergency services are exempt, and cautions that missing preauthorization may affect payment or patient benefits. The guide details required member, diagnosis, procedure, provider identifiers, and clinical information, then provides submission methods via Availity online or Humana phone/fax channels, including how determination notifications are delivered.

LanguageEnglish

CategoryLetters

FormatPDF

Pages3

Reading Time1 min

AccessFree to download

Commercial Preauthorization and Notification List

Purpose and definitions

Emergency exemption and investigational care

Submission requirements

How to request preauthorization

Determination notification and plan scope

Commercial Preauthorization and Notification List After reading the applicability of the preauthorization requirements below, access services, codes and medication by selecting the appropriate link: Commercial July 2023 Medical (physical health)/Behavioral health preauthorization list, please click here Commercial 2023 Medication preauthorization list, please click here We have updated our preauthorization and notification list. This list applies to all commercial fully * insured plans. All services, items and medications that require preauthorization are included in this list. Preauthorization is a process that Humana uses to determine if services are covered by a member’s plan. This process must be followed before the services on this list are performed. The term“preauthorization” is the same as prior authorization, precertification or preadmission. Humana requests notification for some services on this list. This is used to best serve our members. It allows us to place them in programs to provide support for their condition. This process is not the same as preauthorization. Humana does not approve or deny a notification. It is important that preauthorization is obtained for services on this list. By not obtaining apreauthorization, the healthcare provider could be denied payment or there may be a reduction in benefits for the patient. Humana does not require preauthorization or referrals for emergency services. Below are examples of an emergent situation:1 • The health of the sick or injured person (and/or fetus, if the person is pregnant) would be at serious risk • Services are performed when the health of the person would suffer serious damage to bodily functions, organs or other body parts Humana usually does not pay for care considered investigational and experimental. Please refer to the patient’s Certificate of Coverage or contact Humana to ask if the care is covered. Services or medications provided without preauthorization may still be reviewed for medical necessity. We recommend that a healthcare provider make a request for services or medications to verify the member’s benefits. When requesting a preauthorization, please have the following information available as applicable: • Member’s ID number, name and date of birth • Date of service or hospital admission 1The list of examples above is not exhaustive • Procedure codes (up to a maximum of 10 per request) • Diagnosis codes (primary and secondary) (up to a maximum of 6 per request) • Service location • Inpatient (acute hospital, skilled nursing, hospice) • Outpatient (telehealth, office, home, off-campus outpatient hospital, on-campus outpatient hospital or ambulatory surgery center) • Referral (office, off-campus outpatient hospital, on-campus outpatient hospital, ambulatory surgery center, other) • Tax Identification Number (TIN) and National Provider Identifier (NPI) number of treatment facility where service is being rendered • TIN and NPI number of the provider performing the service • Caller/requestor’s name/telephone number • Attending physician’s telephone number • Relevant clinical information • Discharge plans Please submit all of the relevant clinical information at the time of the preauthorization request. This will speed up the process. If additional clinical information is required, we will request it. Humana uses the following policies to determine medical necessity: Medical and Pharmacy Coverage Policies How to request preauthorization: Except where noted via links on the following pages, preauthorization requests for medical services maybe initiated: • Online via [https://www.Availity.com/](https://www.Availity.com/)(registration required) • By calling Humana’s interactive voice response line at 800-523-0023 Please note: Online preauthorization requests are encouraged. For certain preauthorization services requested via Availity, there is an option to complete a questionnai

FAQs

What is the difference between preauthorization and notification in this list?

Preauthorization is the process Humana uses to determine whether services are covered, while notification is requested for certain services to support members through programs and is not a coverage approval or denial decision.

When is preauthorization not required?

Preauthorization and referrals are not required for emergency services, such as when the health of the sick or injured person would be at serious risk or bodily functions and organs would suffer serious damage.

What information is needed to request a preauthorization?

Requests should include the member’s ID, name, and date of birth; date of service or admission; procedure codes and diagnosis codes within stated maximums; service location; inpatient/outpatient details; referral information; TIN and NPI for facilities and providers; caller/requestor contact; attending physician contact; and relevant clinical information including discharge plans.

Sep 17, 2026

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