We want to help make working with us as easy as possible. Below, please find common forms related to prior authorization that you may need to use when providing services for Humana Healthy Horizons^® in South Carolina members.

Prior authorization forms

Universal Prior Authorization Form

Behavioral health prior authorization forms

Applied Behavioral Analysis Authorization Form

Electroconvulsive Therapy Authorization Form

Inpatient and Partial Hospitalization Authorization Form

Inpatient Sub-Acute Authorization Form

Intensive Outpatient Authorization Form

PHP and IOP Behavioral Health Authorization Form

Psychological and Neuropsychological Testing Authorization Form

Residential Authorization Form

Routine Outpatient Authorization Form

Requesting prior authorization

For medical services/procedures and behavioral health

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

• Online via Availity (registration required) Please note: Online prior authorization requests are encouraged
• By accessing Humana’s Medicaid Preauthorization and Notification Lists (PALs)
• By calling Humana’s interactive voice response (IVR) line at 866-432-0001, Monday – Friday, 8 a.m. – 6 p.m., Eastern time
• By calling our authorization intake team directly at 888-285-1114, Monday – Friday, 8 a.m. – 6 p.m., Eastern time
• By emailing CorporateMedicaidCIT@humana.com
• By faxing clinical information for a medical service prior authorization request form to 833-441-0950

 

For pharmacy drugs

Except where noted, prior authorization requests for pharmacy drugs may be initiated:

• By calling 800-555-2546, Monday – Friday, 8 a.m. – 6 p.m., Eastern time

 

When applicable, please use one of the below forms when submitting an authorization request for medication or Synagis^®.

Prior Authorization Request Form: Medications

Prior Authorization Request Form: Universal Synagis®

Learn more about prior authorization in the Humana Healthy Horizons in South Carolina Provider Manual