Member Alert: Important Update on Humana’s Prior Authorization Requirements – 9/6/2024

[Editor’s Note: This information was sent to ICS members on September 6, 2024, the day the update was confirmed in writing in the PAL documents. To receive other updates and alerts like this, please join the ICS here.]

On Thursday, the Illinois Chiropractic Society spoke with Humana’s Director of Clinical Coverage Policy Operations to clarify the recent changes impacting chiropractic care. Although Humana’s previous release stated that preauthorization would be required for all chiropractic services under their Medicare Advantage programs, we have now learned that program is limited to Florida and California only.

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Humana has informed us that their previous releases did not detail the limited application of prior authorization requirements, and they have now provided a more accurate update.

Here’s what we learned:

1. Preauthorization Requirements Limited to Specific Areas: Despite what the Summary of Changes document may have implied, prior authorization (PA) is only required for chiropractors in Southern Florida (Tivity) and Southern California (ASH).
2. Details Available in the Full PAL Document: The full Preauthorization and Notification List (PAL) confirms that the requirement applies only to Southern Florida and Southern California chiropractors. You can find it under the “Medicare Advantage and Dual Eligible Special Needs Plans Preauthorization and Notification List” on Humana’s provider page. Here is the Direct PAL link (See pages 5 and 6).
3. Summary of Changes Document Now Updated: Humana acknowledged the previously issued Summary of Changes lacked state-specific details on the application of the preauthorization program. They have now updated it and removed all references to chiropractic preauthorization, and the revised version is here.

Summary: Chiropractic physicians located in Illinois do NOT need to obtain prior authorization for Humana Medicare Advantage plans.

UnitedHealthcare: As we previously reported, the ICS wrote to UHC to strongly object to its newly implemented, broad-based prior authorization program, effective 9/1/2024.  Unfortunately, we have not received a response and do not have any updates regarding the UHC Medicare Advantage prior authorization requirements.  Therefore, we continue to encourage our doctors to provide patients with our updated advocacy flyer. Find out more here.