For current Prior Auth and Notification list go to Kentucky Prior authorization and notification list.  For previous prior auth and notification lists go to Humana.com/PAL

Near the bottom of the page, you will find prior authorization guidance from the Kentucky Department for Medicaid Services (DMS). We strongly urge our providers to review Kentucky DMS guidance, which outlines changes to existing procedures as well as when such changes go into effect.

How to request prior authorization for medical services

Except where noted, prior authorization requests for medical and behavioral health services may be initiated:

• Online via Availity Essentials® (registration required)
  Please note: Online prior authorization requests are encouraged
• By calling Humana’s interactive voice response line at 800-444-9137, Monday – Friday, 8 a.m. – 6 p.m., Eastern time
• By faxing clinical information for a medical service prior authorization request to 833-974-0059 using the Humana Healthy Horizons in Kentucky Fax Form – State Template or the Humana Healthy Horizons in Kentucky Fax Form – Humana Preferred Template
• Please submit a Clinical Trial Attestation Form with all prior authorization requests for related services

How to request prior authorization for medications

MedImpact is the pharmacy benefits manager (PBM) for all Kentucky health plans offering coverage to Medicaid enrollees. As a result, MedImpact manages all prior authorization requests for medications.

To submit a prior authorization request to MedImpact:

• Call 844-336-2676
• Fax 858-357-2612
• Use the Cover My Meds, Surescripts, or CenterX ePA web portals

Access prior authorization forms to submit authorization requests for your patients with Humana Healthy Horizons® in Kentucky coverage. Please follow the instructions on the form when completing and submitting it.

Please note: Send all medically billed medication prior authorization requests to Humana Healthy Horizons in Kentucky and New Century Health, as outlined below.

Prior authorization partnerships

Avesis

For authorizations related to dental and vision services

Dental: Call 888-211-0599

Vision: Call 844-511-5760

EviCore healthcare

Humana Healthy Horizons in Kentucky and EviCore healthcare partnered to provide authorization services for Kentucky Medicaid enrollees for the following advanced imaging services:

• 3D rendering
• Computed tomography angiography (CTA)
• Computerized tomography (CT) scan
• Magnetic resonance angiography (MRA)
• Magnetic resonance imaging (MRI)
• Nuclear medicine
• Positron emission tomography (PET)
• Single-photon emission computerized tomography (SPECT) scan

Submit authorization requests to EviCore:

• By visiting online at EviCore.com (registration required)
• By calling 866-672-8115, Monday – Friday, 7 a.m. – 7 p.m., Eastern time
• By faxing your request to 800-540-2406

EviCore healthcare will manage physical therapy, occupational therapy, and speech therapy services for Humana Healthy Horizons in Kentucky enrollees, including medical necessity reviews on therapy services that occur after an initial evaluation, for all age groups.

Please have the following clinical information available when requesting a preauthorization:

• Patient’s name, date of birth, and Humana member ID number
• Name of requesting and, if applicable, rendering physician or Tax ID Number
• Telephone, email address, and fax numbers of requesting and, if applicable, rendering physician
• Enrollee’s diagnosis
• Clinical information that supports medical necessity need for skilled therapy services (e.g., presenting symptoms, identify new vs. continuing care, primary area of treatment (if applicable, secondary area of treatment), first indictor of complexity, requested dates, functional score, complexity, progress, clinical assessment)

Submit authorization requests to EviCore:

• By visiting online at EviCore.com (registration required)
• By calling 866-672-8115, Monday – Friday, 7 a.m. – 7 p.m., Eastern time
• By faxing your request to 855-774-1319

EviCore Therapy Provider Orientation

New Century Health

For adults 18 and older, Humana partners with New Century Health for chemotherapy agent-, supportive- and symptom-management-drug prior authorization requests.

For a list of applicable medications, please see our Prior Authorization List.

To submit a prior authorization request to New Century Health, you may:

• Initiate an online request by signing in to New Century Health’s website. If you have not yet received a username and password, please call New Century Health at 855-427-1372, Monday – Friday, 8 a.m. – 8 p.m., Eastern time, and select option 1.
• Call New Century Health’s Intake Coordinator department at 855-427-1372, Monday – Friday, 8 a.m. – 8 p.m., Eastern time, and select option 1.

ProgenyHealth  

Starting May 29, 2025, Humana Healthy Horizons will partner with ProgenyHealth® to conduct admissions and continued-stay reviews for newborns admitted to a neonatal intensive care unit (NICU).

For continued stay reviews, you also may contact ProgenyHealth directly:

• For Utilization Management
  • By visiting online at ProgenyHealth’s provider portal
  • By calling 888-832-2006, Monday – Friday, 8:30 a.m. – 5 p.m., Eastern time (Select option 3)
  • By faxing your request to 866-610-2034
• For Case Management
  • By visiting online at ProgenyHealth’s provider portal
  • By calling 888-832-2006, Monday – Friday, 8 a.m. – 6 p.m., Eastern time (Select option 4)
  • By faxing your request to 855-834-2567

WholeHealth Networks (dba Tivity)

All chiropractic services on the Kentucky DMS fee schedule require prior authorization through Tivity.

To submit a prior authorization request to Tivity for chiropractic services:

• Use the Tivity online portal
• Call 855-800-9804, Monday – Friday, 8:30 a.m. – 5:30 p.m., Eastern time
• Fax 888-492-1025

See Chiropractic Service Retro Authorization Policy.

Prior authorization updates

Visit the Communications and Network Notices webpage to view prior authorization updates.