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Prior authorization submission information

Professionally administered drugs prior authorization

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Prior authorization for professionally administered drugs 

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Humana Healthy Horizons in Florida

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Prior authorization (PA) is the process by which a primary care provider (PCP) or other healthcare provider obtains approval from the plan as to whether an item, drug or service is covered, and is an important component to managed care.

Requests for PA should be made as soon as possible. If PA is required and not obtained, the result may lead to a reduction or denial of payment. Services provided without PA also may be subject to retrospective review. When retrospective reviews are performed, clinical information should be included to perform a medical necessity review. A summary of why PA was not obtained also should be included in the review.

Our PA list can be found at Humana.com/PAL. Please note the PA list is subject to change. Changes to PA requirements are posted to Humana.com/PAL a minimum of 45 days prior to the effective date of the change. Medical services and behavioral health/substance use disorder services are evaluated for addition to or removal from the PA list utilizing factors established in The Mental Health Parity and Addiction Equity Act of 2008.

PA for medications billed as medical claims

How to request prior authorization

PA for medical services

PA for medications billed as medical claims

PA for durable medical equipment

PA for outpatient therapy

PA for clinical trials

PA for behavioral analysis

Florida Medicaid