Humana Prior Authorization Form


PRIOR AUTHORIZATION REQUEST FORM EOC ID: Administrative Product - Universal r r Phone: 800-555-2546 r Fax back to: 1-877-486-2621 r HUMANA INC manages the pharmacy drug benefit for your patient.


O Aetna O Cigna O Secure Horizons O Aetna Golden Medicare Plan O Health Net O Blue Shield 65 Plus O Health Net Seniority Plus O Blue Shield Access Plus O Humana Medicare Advantage O California Care O PacifiCare OBreastfeeding Medicine Referral O O O O ONutrition Consult for Chronic Disease (CMC ...

HUM PM-SS RequestForm7

HUMANA Pain Management & Spinal Surgery Prior Authorization Request Form Rev. 1/1/2011 Copyright 2011 OrthoNet, LLC Instructions: 1. Use this form when requesting prior authorization of spinal surgery or pain management procedures for Humana members.

TRICARE Provider Chart: TRICARE Referrals and Prior Authorization

TRIC ARE ® Referrals and Prior Authorizations Humana Military Healthcare Services, ... 1 Submit online for quickest response Via the "MyHMHS for Providers" portal at Fax Patient Referral Authorization Form 1-877-548-1547 By phone 1-800-444-5445 Contact ValueOptions, ...

Humana Preauthorization and Notification List

Humana MA PFFS Members: For Humana MA PFFS members, ... individual practitioners making specific requests for services are encouraged to verify benefits and authorization requirements prior to providing services.


HUMANA 2008 DRUG LIST CHANGES PRIOR AUTHORIZATION New Prior Authorizations - The following drugs will require prior authorization effective January 1, 2008.

Coverage Review or Prior authorization

Coverage Review or Prior authorization  You can start the process by fax or telephone. By fax 1. Download our online fax form from www.medcohealth. com 2.

HUMANA Request Form9-X

Use this form when requesting prior authorization of therapy services for Humana members. ... Yes No Yes No If this is a HUMANA Medicare Advantage PFFS member, is this request for an Advanced Coverage Determination (ACD)?

2011 Prescription Drug Guide

2011 Prescription Drug Guide Humana Formulary List of Covered Drugs Humana Walmart-Preferred Rx Plan (PDP) ... or add prior authorization, quantity limits, ...

TRICARE Referrals and Prior Authorizations Provider Chart

TRICARE Referrals and Prior Authorizations Referrals Humana Military issues a referral when a TRICARE Prime beneficiary needs specialized medical services from a professional or ancillary provider only if services are not ... Fax the Patient Referral Authorization Form (PRAF) to 1-877-548 ...

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