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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 Kentucky Provider Prior Authorization

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

Upon viewing the Humana Healthy Horizons® in Kentucky (Medicaid) Preauthorization and Notification Lists, 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 may be initiated:

Online via Availity Essentials™ 
Please note: Online prior authorization requests are encouraged

By calling 800-444-9137, Monday – Friday, 8 a.m. – 6 p.m., Eastern time

By faxing your clinical information for a medical service prior authorization request to 833-974-0059 Use 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:

Online, by visiting Cover My Meds®, Surescripts® or CenterX ePA web portals

By calling 844-336-2676, daily, 8 a.m. – 7 p.m., Eastern time

By faxing your request to 858-357-2612

Access prior authorization forms to submit authorization requests for your patients with Humana Healthy Horizons 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 Evolent, as outlined below.

Prior authorization partnerships

DentaQuest/EyeQuest

Submit authorization requests related to dental and vision services:

DentaQuest® Online, by visiting DentaQuest's Provider Portal  

By calling 800-508-6787, Monday – Friday, 8 a.m. – 6 p.m., Eastern time 

By faxing your request to 262-834-3575



EyeQuest® Online, by visiting EyeQuest's Provider Portal 

By calling 844-870-3978, Monday – Friday, 8 a.m. – 6 p.m., Eastern time 

By faxing your request to 888-696-9552



EviCore healthcare

Humana Healthy Horizons in Kentucky and EviCore healthcare partnered to provide authorization services for Humana Healthy Horizons members 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

EviCore healthcare will manage physical therapy, occupational therapy, and speech therapy services for Humana Healthy Horizons members, 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

Member’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:

Online, by visiting EviCore.com (registration required)

By calling 866-672-8115, Monday – Friday, 7 a.m. – 7 p.m., Eastern time

By faxing your hi-tech radiology request to 800-540-2406

By faxing your speech, physical or occupational therapy request to 855-774-1319

EviCore Therapy Provider Orientation

Evolent® (Formerly New Century Health)

For adults 18 and older, Humana partners with Evolent 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 Evolent, you may:

Initiate an online request by signing in to Evolent’s website. If you have not yet received a username and password, please call Evolent at 844-926-4528, Monday – Friday, 8 a.m. – 8 p.m., Eastern time, and select option 1.



By calling 844-926-4528, Monday – Friday, 8 a.m. – 8 p.m., Eastern time, and select option 1.

By faxing your request to 213-596-3783 

ProgenyHealth  

ProgenyHealth® will 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 managementOnline, by visiting ProgenyHealth’s provider portal

By calling 888-832-2006, Monday – Friday, 8:30 a.m. – 5 p.m., Eastern time, and select option 3

By faxing your request to 866-610-2034



For case managementBy 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:

Online, by visiting the Tivity online portal

By calling 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.

For prior authorization updates, please visit our Communications and Network Notices webpage. 

Prior authorization information and routing information

Kentucky Medicaid