08/18/2026

Humana

Clinical Documentation Attachments Required for Authorizations Submitted via Availity Essentials

Effective Jan. 1, 2026, the Centers for Medicare & Medicaid Services (CMS) requires prior authorization (PA) decisions within seven calendar days for standard (non-urgent) requests for medical items and services (See CMS Interoperability and Prior Authorization Final Rule - CMS-0057-F).

Humana is committed to maintaining the new streamlined time frame for PA decisions in accordance with this rule. To comply, all supporting clinical documentation must be submitted at the time of the PA request. Beginning May 16, 2026, providers submitting outpatient Medicare authorization requests for PA services via the Availity Essentials™ portal will be required to upload supporting clinical documentation. Exceptions may apply.  READ MORE

Provider Prior Authorization Notification Lists

Access a list services and medications that require prior authorization for patients with Medicaid, Medicare Advantage and dual Medicare-Medicaid coverage.  CLICK HERE

Drug Lists for Providers

To learn about formulary-related information for your Humana-covered patients.  CLICK HERE

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