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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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Telephonic case and care management program

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Our patient-centric, Individualized Care Plan (ICP) is developed with an Interdisciplinary Care Team (ICT), which includes the Humana Care Manager and the primary care physician.

Review eligibility and qualifying conditions

Services are available for select and qualifying Medicare and Medicaid members, including:

High-risk members in Medicare Advantage plans

Illinois Medicaid & Medicare members under the Humana Gold Plus® Integrated Medicare-Medicaid health plan

Members in D-SNP and C-SNP plans are automatically enrolled.*

*A referral increases the likelihood members will engage with Humana Care Management. SNP members that engage with Humana Care Management have 12% higher HEDIS score.

Examples of qualifying conditions

Patients who may be eligible for Humana Care Management include those who:

Have a comorbid/medically complex chronic condition OR a poorly controlled health condition that significantly limits overall health/function AND:Requires intensive care coordination OR additional support OR

Requires extensive resources and/or services to regain optimal health   



Are at high risk for hospitalization due to a medical condition that requires longer‐term support

Require frequent adjustments in their treatment plan

Lack resources or the ability to self‐manage (i.e., food insecurity, unstable housing, lack of transportation or inability to afford medications)    



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