Humana Prior Authorization Fax Number

Which line takes which drug request

Humana’s prescriber quick reference guide splits medication requests by how the drug is billed:

• A drug the pharmacy supplies and bills through the pharmacy benefit. Fax (877) 486-2621 to Humana Clinical Pharmacy Review, for prior authorization, step therapy, quantity limits and medication exceptions.
• A drug supplied and given in the physician’s office and billed as a medical claim. Fax (888) 447-3430 to the Humana Medication Intake Team, using the medication’s own fax form or the Universal form if it has none.

Humana’s Medicaid plans can differ by state, so check the state’s Humana page. Florida’s Medicaid pharmacy page prints the same (877) 486-2621 and has the doctor send the request.

Medical services by fax

Humana’s provider prior authorization page says most of these go through Availity and some go to a review partner. Each service opens to its own instructions, and these are the fax lines it lists:

• Advanced imaging, cardiac interventions and devices, endoscopy, and orthopedic surgery, pain management and therapy. Cohere Health, fax (857) 557-6787.
• Ablation, radiation oncology, chemotherapy for oncologic disorders in patients older than 18, and the surgical services Evolent reviews. Evolent, fax (213) 596-3783. For ablation, radiation oncology and surgery, the page names the plans Evolent reviews as Medicare HMO and PPO plans and Illinois dual Medicare-Medicaid, and sends private fee-for-service surgical requests to the clinical intake phone.
• Molecular diagnostic and genetic testing. Fax (855) 227-0677.
• Transplant, VAD, CAR-T and gene therapy. Fax (502) 508-9300.

The page carries exceptions by plan and state, such as states where Humana rather than Cohere reviews imaging, so open the service on that page before you send. For a service the page does not show, Humana’s clinical intake team is on (800) 523-0023.

Other ways to reach Humana Clinical Pharmacy Review

Humana also takes pharmacy prior authorization through CoverMyMeds, which it describes as a free service for any Humana plan, and by phone at (800) 555-2546, Monday to Friday. A fax request means completing the applicable form first.

Several states mandate their own form for commercial fully insured members, including Arizona, California, Colorado and Louisiana. Humana lists those forms on its Prior Authorizations page. Follow the instructions on the form you use.

What to send

Humana’s Medicare coverage determination form, which goes to the pharmacy line, asks for:

• The enrollee’s name, date of birth, address, phone and member ID
• The drug being requested
• The type of request, such as prior authorization or an exception to a quantity limit
• The prescriber’s office phone and fax, and any supporting statement

The form says the prescriber may ask for a coverage determination on the enrollee’s behalf, and anyone else making the request has to be the enrollee’s representative.

Check the line against the form

Humana runs separate lines for drugs, for services, and for the partners that review some of them. A request on the wrong line waits while it is rerouted.

• Decide first whether it is a drug or a service, and for a drug, how it is billed.
• Read the number on the form you downloaded from Humana. If the form prints a different one, follow the form.
• Keep the delivery confirmation with the chart. It shows the fax reached the number, not that Humana has decided the request.

Sending from the practice

Humana’s form asks for the prescriber’s office fax. Every paid FaxTerra plan includes a number that receives, and incoming faxes arrive in an inbox on the web and in the mobile app.

A practice covered by HIPAA adds HIPAA compliance to its plan for $4.99 a month and signs a Business Associate Agreement before sending any PHI. Neither the free plan nor a paid plan without the add-on includes a BAA.