Your Practice de Humana

Radiation therapy services have been added to Humana's commercial and Medicare Advantage (MA) Preauthorization and Notification lists. Estos servicios serán administrados por HealthHelp, una organización de administración de beneficios de radiología reconocida a nivel nacional. Preauthorization requests for radiation therapy services can be submitted through HealthHelp's RadConsult^TM program.

The program promotes the appropriate utilization of radiation therapy treatments consistent with the National Comprehensive Cancer Network (NCCN) Guidelines. The NCCN is an alliance of the world's leading cancer centers working together to develop treatment guidelines for most cancers and dedicated to research that improves the quality, effectiveness and efficiency of cancer care. Additional information is available at http://www.nccn.org.

two-dimensional (2D) and three-dimensional (3D) conformal radiation
intensity-modulated radiation therapy (IMRT)
brachytherapy
stereotactic radiation therapy
proton-beam procedures

These new radiology benefit management services will support physicians as they help their Humana-insured patients obtain prompt access to imaging exams and radiation oncology treatments, without unnecessary radiation exposure.

The radiation therapy services program will apply to Humana fully insured commercial members and to Medicare members. Physicians for Humana Medicare Private-Fee-for-Service members are requested to provide notification only. Exclusions from this requirement include the following: Arizona and Puerto Rico commercial and Medicare Advantage (MA) members, Florida MA HMO members, Ochsner MA HMO members, Health Care Partners MA HMO members and Chicago risk and delegated providers.

Requesting preauthorization/prenotification
Physician practice staff members can use RadConsult to submit orders for individual diagnostic imaging exams and complete radiation therapy treatment plans quickly and conveniently via the Internet or through a voice-activated call system. The call system also allows staff members to quickly check procedure request status and verify authorization numbers. Procedure requests that don't correlate with RadConsult's evidence-based criteria are checked first by clinical reviewers. When necessary, physicians may consult with board-certified radiologists and radiology subspecialists affiliated with leading academic institutions through RadConsult.

When requesting preauthorization or providing notification of Humana members' radiation therapy treatment plans, please have the following information available:

Radiation treatment modality ordered (CPT code)
Number of fractions/total radiation dose
Prior surgical intervention
Cancer stage/performance status
Prior radiation treatment

When requesting preauthorization or providing notification for diagnostic imaging, please have the following information available:

Physician information
Patient history and Humana ID number
Preliminary diagnosis
CPT code
Procedure requested

To request preauthorization, follow these simple steps:

Step 1: Log on to RadConsult by clicking https://portal.healthhelp.com/Humana/default.asp or call 1-866-825-1550 (7 a.m. to 7 p.m. Central time, Monday through Friday, and 9 a.m. to 4 p.m. Central time, on Saturday).
Step 2: You will be prompted to provide the information stated above.
Step 3: Following immediate assessment, you will be given an authorization/notification number. If the information is incomplete or does not meet evidence-based criteria for the procedure requested, you will be contacted for clarification in order for an authorization/notification number to be issued.