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It identifies services and medications requiring prior authorization and highlights alignment with Medicare coverage guidance and medical necessity. It also clarifies investigational exclusions, plan-specific applicability across HMO, PFFS, and PPO, and when an advance coverage determination (ACD) can be requested. Urgent/emergent services are treated differently, with guidance to avoid penalties and delays.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/humana-dual-highly-integrated-michigan-prior-authorization-and-notification-list-effective-jan-1-2026/288813/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/humana-dual-highly-integrated-michigan-prior-authorization-and-notification-list-effective-jan-1-2026/288813.png","ImageObject",442,249,{"name":88,"@type":89},"Cipher","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-11","2026-09-17",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",9,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"How does Humana define “prior authorization” in this communication?","Question",{"text":109,"@type":110},"Prior authorization is a process where the physician or healthcare provider must obtain advance approval from the plan on whether an item or service will be covered.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What does “notification” mean, and how does it differ from prior authorization?",{"text":114,"@type":110},"Notification is when the provider informs Humana of intent to provide an item or service. Humana does not issue an approval or denial for notifications, unlike prior authorization.",{"name":116,"@type":107,"acceptedAnswer":117},"When are prior authorization or notification not required?",{"text":118,"@type":110},"Urgent/emergent services do not require referrals, prior authorization, or notification, and basic Medicare benefits in the first 90 days of a new member’s enrollment are handled differently.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},288813,1791119824,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":136,"language":137,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":138,"faqs":139,"seo_title":140,"seo_description":61,"update_tm":141,"read_time":15},687208528416,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Humana Dual Highly Integrated Michigan Prior Authorization and Notification List  \nWe have updated our prior authorization and notification list for Humana Dual Highly Integrated Michigan.  \nPlease note that the term “prior authorization”(prior authorization, precertification, preadmission), when used in this communication, is defined as a process through which the physician or other healthcare provider is required to obtain advance approval from the plan as to whether an item or service will be covered.  \n“Notification” refers to the process by which the physician or other healthcare provider notifies Humana of the intent to provide an item or service. Humana requests notification, as it helps coordinate care for Humana-covered patients. This process is distinguished from prior authorization. Humana does not issue an approval or denial for notifications.  \nThe list details services and medications (i.e., medications that are delivered in the physician’s office, clinic, outpatient or home setting) that require prior authorization prior to being provided or administered. Services must be provided according to Medicare coverage guidelines established by the Centers for Medicare & Medicaid Services (CMS). According to the guidelines, all medical care, services, supplies and equipment must be medically necessary. You can review Medicare coverage guidelines on the CMS website.  \nTo view Humana’s medical coverage policies, please visit  Humana's Medical and Pharmacy Coverage Policies webpage.  \nInvestigational and experimental procedures and devices usually are not covered benefits. Please consult the patient’s Evidence of Coverage or contact Humana for confirmation of coverage.  \nPlease note that certain services may not be covered under the member's plan.  \nImportant notes:  \nHumana MA health maintenance organization (HMO): The full list of prior authorization requirements applies to patients with Humana MA HMO and HMO point-of-service (HMO POS) coverage. Healthcare providers who participate in an independent physician association (IPA) or other risk network with delegated services are subject to the prior authorization list and should refer to their IPA or risk network for guidance on processing their requests including services treated by non-contracted providers. Exclusions may change, so please refer to [Provider.Humana.com](Provider.Humana.com) for the most up-to-date information. Choose “Authorization & Referrals” at the bottom of the page and then the appropriate topic.  \nHumana MA private fee-for-service (PFFS): Prior authorization is not required for MA PFFS plans. However, notification is requested, as it helps coordinate care for Humana-covered patients. Physicians and healthcare providers can request an advance coverage determination (ACD) for review and determination of coverage in advance of the services being provided on behalf of the patient for any service not on our prior authorization list. See “Advance Coverage Determinations”for instructions.  \nHumana MA preferred provider organization (PPO): The full list of prior authorization requirements applies to patients with Humana MA PPO coverage.  \nHumana Medicare Supplement plan: This list does not apply to policyholders of a Humana Medicare Supplement plan.  \n• All Humana MA plans – For procedures or services that are investigational or experimental (or that may have limited benefit coverage), or to learn if Humana will pay for a service, you can request an ACD on behalf of the patient prior to providing the service. You may be contacted if additional information is needed.  \no ACDs for medical services can be initiated by submitting a written, fax or telephone request:  \n• Mail written requests to:  \nHumana Correspondence  \nP.O. Box 14601  \nLexington, KY 40512-4601  \n• Submit by fax to 800-266-3022.  \n• Submit by phone at 800-523-0023.  \no ACDs for medications on the list can be initiated by submitting a fax or telephone request:  \n• Submit by fax to 888-447-3430.  \n•","cbCaigvuBpz7tgue","https://ap.wps.com/l/cbCaigvuBpz7tgue","pdf",399131,34,"English","# Prior authorization and notification definitions\n## Services and medications requiring prior authorization\n## Plan-specific applicability and exclusions\n## How to request an ACD and required information\n## Effective date and CMS 7-day decision timeline","[{\"question\":\"How does Humana define “prior authorization” in this communication?\",\"answer\":\"Prior authorization is a process where the physician or healthcare provider must obtain advance approval from the plan on whether an item or service will be covered.\"},{\"question\":\"What does “notification” mean, and how does it differ from prior authorization?\",\"answer\":\"Notification is when the provider informs Humana of intent to provide an item or service. Humana does not issue an approval or denial for notifications, unlike prior authorization.\"},{\"question\":\"When are prior authorization or notification not required?\",\"answer\":\"Urgent/emergent services do not require referrals, prior authorization, or notification, and basic Medicare benefits in the first 90 days of a new member’s enrollment are handled differently.\"}]","Humana Dual Highly Integrated Michigan Prior Authorization and Notification List - Effective Jan. 1, 2026 | PDF",1789633992]