During this time, you can still find all forms and guides on our legacy site. Meaning, you should contact your plan directly to confirm coverage. The requested clinical should be faxed to Medical Management, using the appropriate fax number for the service for which authorization is requested. For New Mexico residents: Insured by Humana Insurance Company. If you are unable to use electronic prior authorization, you can call us at 1 (800) 882-4462 to submit a prior authorization request. A .mass.gov website belongs to an official government organization in Massachusetts. Cal MediConnect (PDF) Medi-Cal Fee-for-Service Health Net and CalViva Health (PDF) Los Angeles, Sacramento, San Diego, San Joaquin, Stanislaus, and Tulare counties; Fresno, Kings and Madera counties (CalViva Health) Requesting providers must initiate a request for prior authorization for non-urgent health-care services prior to delivering the requested service, medical supply equipment or clinician administered drug. Via Telephone The following information is generally required for all authorizations: As a registered provider, you can submit authorization requests and download or print a summary report for your records. Failure to notify within the timeframe required will result in a late notification denial, unless otherwise stated within a Superior contract. Coming Soon Lists Effective April 1, 2023, April 1, 2023, Medicare and Dual Medicare-Medicaid Plans Preauthorization and Notification List, April 1, 2023, Commercial Preauthorization and Notification List, Coming Soon Lists Effective February 1, 2023, February 1, 2023 Humana Healthy Horizons in Kentucky (Medicaid) Preauthorization and Notification List, PDF, Coming Soon Lists Effective January 1, 2023, January 1, 2023, Humana Healthy Horizons in Florida (Medicaid) Preauthorization and Notification List, PDF, January 1, 2023, Humana Healthy Horizons in Louisiana (Medicaid) Preauthorization and Notification List, PDF, January 1, 2023, Humana Healthy Horizons in South Carolina (Medicaid) Preauthorization and Notification List, PDF, Jan. 1, 2023, Humana Gold Plus Integrated Illinois Dual Medicare-Medicaid Plan Preauthorization and Notification List, Jan. 1, 2023, Medicare and Dual Medicare-Medicaid Plans Preauthorization and Notification List, PDF, Jan. 1, 2023, Commercial Preauthorization and Notification List, PDF, Jan. 1, 2023, Part B Step Therapy Preferred Drug List, PDF, Coming Soon Lists Effective December 1, 2022, December 1, 2022 Humana Healthy Horizons in Ohio (Medicaid) Preauthorization and Notification List , PDF, October 1, 2022, Humana Healthy Horizons in Kentucky (Medicaid) Preauthorization and Notification List, PDF, August 1, 2022, Medicare and Dual Medicare-Medicaid Plans Preauthorization and Notification List, PDF, August 1, 2022, Commercial Preauthorization and Notification List, PDF, May 1, 2022, Humana Healthy Horizons in South Carolina (Medicaid) Preauthorization and Notification List, PDF, Feb. 1, 2022, Humana Healthy Horizons in Florida (Medicaid) Preauthorization and Notification List, PDF, Jan. 1, 2022, Part B Step Therapy Preferred Drug List, PDF, September 1, 2022, Humana Healthy Horizons in Kentucky (Medicaid) Preauthorization and Notification List, PDF, Feb. 1, 2022, Humana Healthy Horizons in Kentucky (Medicaid) Preauthorization and Notification List , PDF, Feb. 1, 2022, Humana Healthy Horizons in South Carolina (Medicaid) Preauthorization and Notification List, PDF, Jan. 1, 2022, Medicare and Dual Medicare-Medicaid Plans Preauthorization and Notification List, PDF, Jan. 1, 2022, Commercial Preauthorization and Notification List, PDF, Oct. 1, 2021, Humana Healthy Horizons in Kentucky (Medicaid) Preauthorization and Notification List , PDF, Aug. 1, 2021, Humana Healthy Horizons in Florida (Medicaid) Preauthorization and Notification List, PDF, July 1, 2021, Humana Healthy Horizons in South Carolina (Medicaid) Preauthorization and Notification List, PDF, Jan. 1, 2021, Commercial Preauthorization and Notification List , PDF, Jan. 1, 2021, Medicare and Dual Medicare-Medicaid Plans Preauthorization and Notification List, PDF, Jan. 1, 2021, Part B Step Therapy Preferred Drug List, PDF, Jan. 1, 2020, Commercial Preauthorization and Notification List, PDF, Jan. 1, 2020, Medicare and Dual Medicare-Medicaid Plans Preauthorization and Notification List, PDF, Jan. 1, 2020, Part B Step Therapy Preferred Drug List, PDF, Jan. 1, 2020, Kentucky Medicaid Preauthorization and Notification List, PDF, Specific medical and pharmacy coverage criteria and updates, Medical coverage criteria updates and recent changes, PDF, How to register for the Availity Portal, PDF, Streamline preauthorizations and referrals, PDF, Indiana preauthorization request form, PDF, New Mexico preauthorization request form, PDF, State-specific preauthorization statistics, Colorado preauthorization statistics medical, Colorado preauthorization statistics pharmacy, Georgia preauthorization statistics medical, Georgia preauthorization statistics pharmacy, Illinois preauthorization statistics medical, Illinois preauthorization statistics pharmacy, Texas preauthorization statistics medical, Texas preauthorization statistics pharmacy. YzMwMmMzMjgyYTU2NjZkMDUzNzcxMGVmN2Q3OGJjNmRkMTMxMmUzODRlMzk2 877-207-4900. MDFlOTg5MTJkNDhiNjZiNmRhMzk2MGU1ZjY5M2I4ZmVlNWZiZWZlYjM1NzRj Our hours of operation are Monday through Friday, 8am to 8pm. Following notification of admission, concurrent and/or retrospective utilization review is conducted to confirm the continued medical necessity of the inpatient stay. In all states but Florida and Minnesota, it is offered as a supplementary medical plan, not a Medicare plan. 4. ) or https:// means youve safely connected to the official website. At least annually, an assessment is completed to validate the consistency clinical reviewers apply clinical criteria in case reviews. ZDk2NDIwNzFhMTI4ZTM2MzVhZTVkNWMxM2VmY2EzM2JmNTljMTk5ODYyOGIz Fax requests for treatment to 1.866.616.6255. Fax requests: Complete the applicable form below and fax it to 1-855-681-8650. eyJtZXNzYWdlIjoiZjRmZTc3NTc1MjdiM2NlZjUwOTI5MWY3MjA2MWQ1MTk2 In the event of any disagreement between this communication and the plan document, the plan document will control. All services or procedures are subject to benefit coverage, limitations and exclusions as described in applicable plan coverage guidelines. Molina Healthcare/Molina Medicare Prior Authorization Request Form Phone Number: (888) 483-0760 Medicaid/CHIP Fax Number: (866) 472-0589 Medicare Fax Number: (866) 504-7262 Member Information We will use this information to improve the site. Contains key phone numbers and information on claims, appeals and more. LOG OFF IMMEDIATELY if you do not agree to the conditions stated in this warning. Puerto Rico prior authorization. Under Prior Authorization, benefits are only paid if the medical care has been pre-approved by Medicare. Request Network Participation, Non-Contracted Providers Only, Add a Provider to an Existing Group Contract, Add a Practice Location to an Existing Contract, Practice Improvement Resource Center (PIRC), Updating Provider Demographic Information, Effective 1/1: Electronic Prescribing of Controlled Substances Required, Effective September 1, 2021: Benefit Changes to Total Disc Arthroplasty for Medicaid and CHIP, Effective July 15, 2021 through December 31, 2021: Temporary Relaxation of Prior Authorization Requirements for DME, Orthotic, and Enteral/Parenteral Nutrition and Medical Supplies, Javelina legend and NFL hall of famer Darrell Green gives back to Kingsville, Superior HealthPlan, Pro Football Hall of Famer Darrell Green Help Make First Back-to-School Community Fair & Fest in Kingsville a Success, Provider Notice of Adverse Benefit Determinations, Superior to Override Timely Filing for Claims Impacted by Texas Medicaid Healthcare Partnerships (TMHP) Eligibility Verification Issues, 2021 Prior Authorization Denial and Approval Rates CHIP (PDF), 2021 Medicaid Prior Authorization Annual Review Report (PDF), 2021 Medicaid Prior Authorization Change Log (PDF), 2020 Medicaid Prior Authorization Annual Review Report (PDF), 2020 Medicaid Prior Authorization Change Log (PDF). You can find these forms by selecting Providers from the navigation bar on this page, then selecting Forms from the Medicare sub-menu. ODRlNWViYjlhMWVmNDJkNDA0YzI0ODg2MzNjNzNjMjgxOTE5ZDgwMDNkNjE4 ZWVkNGEwYzJhMDUxZmM4Y2M4ZDNhZmRjZWZjZWRlZWIwZmUyN2VlOTViNmVj Prior Authorization LookUp Tool. Plans, products, and services are solely and only provided by one or more Humana Entities specified on the plan, product, or service contract, not Humana Inc. Not all plans, products, and services are available in each state. MzQzOWRiMjgwNjg0OTFiOGQ4MDUyYTMzYzI4Njk3ODViMGZlZTJkYTBjY2I2 YTI0Mjg2OTFhMDhiNGU1OTU1YzM4MTNjNDgwMDhjNjcwMmI0MmE5MzA4ZDg0 Prior Authorization Forms and Policies. Your feedback will not receive a response. MDlkNjNhY2EyMDI2YWIzYWU1YmZlMGY4ZjcyZWY2M2IxMDFiZDcxNGI5OGRl Failure to obtain the necessary prior authorization from WellCare could result in a denied claim. You can report suspected fraud or any other non-compliance activity by calling our Member Services Department at 877-336-2069 or TTY at 877-206-0500. You may also ask us for a coverage determination by phone at (877) 336-2069. Who May Make a Request: In addition, an electronic tool is available on Superiors website that provides procedure code specific information for the services, supplies, equipment and Clinician Administered Drugs (CAD) that require prior authorization. It is very important that the NPI and TIN supplied for the authorization request is the same NPI and TIN that will be included on the claim. NDg3OWNjZDRhZDRjZjg4NTRiYjAyNjc3YWUxNTJiYzM5MDk5MzJhMzNlZGVi The member/patient receives a written notice of the request for submission of the incomplete clinical information. Step 1 - At the top of the Global Prescription Drug Prior Authorization Request Form, you will need to provide the name, phone number, and fax number for the "Plan/Medical Group Name.". You can report suspected fraud or any other non-compliance activity by calling our Member Services Department at 877-336-2069 or TTY at 877-206-0500. . To access the phone numbers for inpatient notification and prior authorization for each applicable service type, please refer to the. Hours: 8 a.m. to 6 p.m. local time, Monday through Friday. Do not include sensitive information, such as Social Security or bank account numbers. Submitting for Prior Authorization. NTE0NWY3ZGNjMjQ1Yjk5MThkODcyMmMzZmY1OGVhNzY0ZjY5ZjBmYmJiYjA0 Some plans may also charge a one-time, non-refundable enrollment fee. Authorization requests that are emergent or urgent should be submitted via telephone. Statements in languages other than English contained in the advertisement do not necessarily reflect the exact contents of the policy written in English, because of possible linguistic differences. Download the free version of Adobe Reader. > 3: you will need Adobe reader to open PDFs on this for. 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