Requests for PA should be made as soon as possible but at least 14 days in advance of the service date. If PA is required and not obtained, it may result in 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 should also 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/SUD services are evaluated for addition to or removal from the PA list, utilizing factors established in the Mental Health Parity Addiction and Equity Act of 2008.

Humana Healthy Horizons does not require referrals from primary care physicians (PCPs) to see participating specialists; however, prior authorization must be obtained to see nonparticipating providers. Members may self-refer to any participating provider.

If a member requires medically necessary services from a nonparticipating provider, the provider may call the Provider Services Contact Center to obtain prior authorization at 855-223-9868 (TTY: 711), Monday through Friday, 8 a.m. to 5 p.m. Central time to obtain prior authorization.

Oklahoma Medicaid pharmacy PA request form

Oklahoma Medicaid physician administered drug PA form

Oklahoma Medicaid medical/behavioral PA request form

Oklahoma Medicaid out of state PA form

Oklahoma Medicaid therapy services PA form

Oklahoma Medicaid step therapy exception request form

Utilization management department

The utilization management (UM) department performs all UM activities including prior authorization, concurrent review, discharge planning and other related UM activities for medical and behavioral health.

Contact information for prior authorization

• PA assistance for medical procedures and behavioral health: 855-223-9868
• PA assistance for pharmacy: 800-555-2546
• Availity