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Review prior authorization lists for services, medications and submission guidance.

Prior authorization submission information

Professionally administered drugs prior authorization

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Prior authorization for professionally administered drugs 

Locate state-specific resources for Humana Healthy Horizons® (Medicaid).

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Humana Healthy Horizons in Kentucky Provider Prior Authorization

Please visit Humana.com/PAL for current and previous prior authorization and notification lists.

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 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.

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

Humana: Clinical trial attestation form requirement

Humana: Notice of changes to PT/OT/ST preauthorization requirements – Sep. 1, 2022

KDMS: Prior authorization guidance for SUD residential and inpatient treatment services – May 5, 2022

KDMS: Prior authorization guidance for inpatient and outpatient Medicaid services – March 16, 2022

Humana: Prior authorization guidance for chiropractic retroactive submissions – Jan. 17, 2022

Humana: Prior authorization guidance including Chiropractic Service Partnership – Oct. 1, 2021

KDMS: Prior authorization guidance from KDMS – Aug. 12, 2021

KDMS: Prior authorization guidance from KDMS – April 26, 2021

Humana: eviCore Partnership for Authorization Services

KDMS: Prior authorization guidance from KDMS – Feb. 1, 2021

Archived

Prior authorization information and routing information

Kentucky Medicaid