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  • Humana Prior Authorization Form

Get Humana Prior Authorization Form

(Faxing Agents Full Name) P a t i e n t R e f e r r a l F o r m Physician Information Patient Information Physician s Name: Patient s Name: Address: Address: City: State: Zip: City: Office Contact: State: Zip: Date of Birth: Telephone: Fax: M F Patient ID #: State License #: Daytime Telephone #: DEA #: Sex: UPIN#: Evening Telephone #: Emergency Contact & Relation: Primary Insurance Information Contacts Telephone#: Secondary Insurance.

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The following information is generally required for all prior authorization letters. The demographic information of the patient (name, date of birth, insurance ID number and more) Provider information (both referring and servicing provider) ... Requested service/procedure along with specific CPT/HCPCS codes.

All you need is your member ID or Medicare ID, date of birth and ZIP code. Go to the Start your online Humana profile activation page. Choose “I'm a Member” and select the “Start activation now” button. Select your member type and enter your ID number, date of birth and ZIP code.

Once you receive your Humana Spending Account Card in the mail, you must activate it before you can use it. Visit Healthy Benefits Plus™ or call 855-256-4620 (TTY: 711) to activate your card.

The prior authorization process begins when a service prescribed by a patient's physician is not covered by their health insurance plan. Communication between the physician's office and the insurance company is necessary to handle the prior authorization.

Call Humana's provider call center at 800-448-6262.

Phone requests: Call 1-800-555-CLIN (2546), Monday – Friday, 8 a.m. – 8 p.m., local time. Fax requests: Complete the applicable form and fax it to 1-877-486-2621.

Insurance companies can deny a request for prior authorization for reasons such as: The doctor or pharmacist didn't complete the necessary steps. Filling the wrong paperwork or missing information such as service code or date of birth.

You can check the balance of your OTC Allowance benefit by calling the number on the back of your Humana Spending Account Card: 855-396-0691 (TTY: 711), 24 hours a day, 7 days a week.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232