What this means for you
Humana is implementing a unified set of processes and procedures to better support both members and providers. While some existing workflows may change, Humana will notify you in advance of any updates that could impact your practice.
- Your local provider engagement and contracting teams remain unchanged. They will continue to support your practice as they do today.
- No changes are being made to how you submit clinical information or prior authorization requests.
- Starting October 1, the peer-to-peer preview process will be managed differently:
- A pre-determination peer-to-peer review will still be available prior to a medical necessity decision.
- If requested, a Humana physician reviewer will attempt direct outreach.
- If an adverse determination is made, you may request a pre-claim provider dispute (PCPD) within seven days of the denial date—or at any time while the member is still in-house.
- You can request a PCPD clinical re-review or a peer-to-peer review (if one wasn’t completed prior to the determination) by calling 800-901-1973 or emailing [email protected].
If you have any questions, please contact Humana at 800-457-4708.