Authorizations Tip Sheet for Claim Denials

This tip sheet provides guidance for healthcare providers regarding the preauthorization process for services covered under Humana Medicare Advantage and commercial plans. It outlines the necessity for providers to request preauthorization before delivering services that require it. The document specifies that referrals, PPO waivers, HMO exceptions, advanced coverage determinations, and notifications are not included in this guidance. It also includes resources for providers, such as the preauthorization and notification lists available at Humana.com/PAL and clinical criteria found at Humana.com/CoveragePolicies and CMS.gov. Additionally, the tip sheet explains the redirection process for preauthorization requests that should be submitted elsewhere and emphasizes that urgent services typically do not require preauthorization, although inpatient admissions may. The information is regularly reviewed to ensure accuracy and relevance, and providers are encouraged to stay updated through the Making It Easier series.