Humana legal entities that offer, underwrite, administer or insure insurance products and services.

Humana Dual Integrated (HMO D-SNP) in Michigan

Provider reviewing a chart with a senior patient in wheelchair

Use the Provider prior authorization search tool to verify authorization requirements. You can search by Current Procedural Terminology (CPT®) code, procedure or drug name.

Provider Prior Authorization Search Tool

Humana covers a wide range of services and medications that may require prior authorization for Humana Dual Integrated (HMO D-SNP) members in Michigan. Please review all lists carefully, including any noted exclusions or special instructions, before submitting your request.

Current Prior Authorization and Notification List (effective Jan. 1, 2026)

Future Prior Authorization and Notification List (effective July 1, 2026)



How to request prior authorization for medical services

Except where otherwise noted, providers can initiate prior authorization requests for medical and behavioral health services in the following ways:

Sign in to Availity Essentials™ (registration required).

Submit a batch Health Care Services Review and Response transaction (278) via electronic data interchange (EDI).

Use our interactive voice response system (IVR) by calling the number listed on the back of the member’s Humana ID card.

For expedited requests due to the seriousness of a member’s condition, call the dedicated expedited request line listed on the back of the member’s Humana ID card.

If a nonparticipating provider needs to request medically necessary services, call the Humana Clinical Intake team at 877-264-2544 (see the number on the member’s card), Monday – Friday, 7 a.m. – 8 p.m., Eastern time.

You can view the status of your prior authorization requests by visiting Availity Essentials.

Medicaid behavioral health and substance use disorder authorization

The Michigan Department of Health and Human Services (MDHHS) provides a benefit grid, the Medicaid Behavioral Health and Substance Use Disorder (SUD) Authorization and Payment Responsibility Grid, to help providers, health plans and enrollees understand covered services and reimbursement responsibilities.

Requesting prior authorization for medications

Humana Dual Integrated (HMO D-SNP) enrollees have access to an integrated formulary that includes both Medicare and Medicaid pharmacy benefits. For more information, refer to the Medicare pharmacy provider manual.

Providers can request medication coverage determinations, including prior authorization, step therapy, quantity limits and formulary exceptions, by:

Obtaining forms on our prior authorization for pharmacy drugs webpage

Submitting requests electronically via Availity Essentials or CoverMyMeds

Faxing requests to the pharmacy prior authorization fax number listed on the member’s card

Calling Humana Clinical Pharmacy Review (HCPR) at 800-555-CLIN, Monday – Friday, 8 a.m. – 11 p.m., Eastern time

For additional information, refer to your provider manual or contact the appropriate Humana support channel.

Note: Always review the most current prior authorization lists and instructions before submitting your request. For further guidance or support, please contact your Humana Provider Engagement representative.

How to determine if prior authorization is required

Previous prior authorization lists

Michigan D-SNP