Prior authorization to Humana

Humana's Gold Card program exempts eligible high-performing providers from PA requirements on specific procedures. Before filing a PA request, confirm whether this provider qualifies for Gold Card status and whether the procedure falls within the exempt list — submitting an unnecessary PA creates administrative burden with no benefit. For non-exempt procedures, Humana covers Medicare Advantage, commercial, and Medicaid members.

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Humana

CommercialMedicare AdvantageMedicaid

PA Fax: +18004867047
PA Phone: +18008002583
Standard turnaround: 3 business days
Urgent turnaround: 72 hours

Humana uses Gold Carding for eligible providers. Check if the procedure requires PA first.

Humana provider portal →

What you'll need

★ PortalFaxPhonePortal preferred

☐Verify Gold Card status — eligible providers may skip PA for some procedures
☐Confirm procedure actually requires PA (Humana has a broad PA-required list)
☐Ordering provider NPI
☐Patient member ID
☐ICD-10 diagnosis code(s)
☐CPT procedure code(s)
☐Clinical notes supporting medical necessity

▶Common denial reasons

⚠PA submitted for a Gold Card-exempt procedure (unnecessary)
⚠Missing clinical documentation for non-exempt procedures
⚠Cosmetic or excluded service
⚠Formulary alternative not tried first

Verified 2026-05-20. Check payer site for current rules →

From $2.99 per submission

PA Agent requires an account so you can track submissions, record outcomes (approved/denied), and pre-fill appeals automatically. It's free to join.

You can preview the form below — sign in before generating or submitting.

⬆ Import from CSVDownload template

Submission checklist

○Provider name, NPI, practice name

○Provider phone & fax number

○Patient name, DOB, member ID

○ICD-10, diagnosis, CPT, procedure

○Clinical notes (min 50 chars · 0 entered)

✓Fax destination number

○AI justification generated & reviewed

1 of 7 checks complete

Prior Authorization Request

1. Provider Information

Provider Name *

NPI * (10 digits)

Practice Name *

Provider Phone *

Provider Fax *

2. Patient & Insurance

Patient Name *

Date of Birth * (MM/DD/YYYY)

Member ID *

Group Number

💬 Patient notifications: add the patient's email below and they'll automatically receive an email when you record the insurer's decision on the tracking page — no phone call needed.

Patient Email (for outcome notifications)

Patient Phone (for future SMS notifications)

3. Clinical Details

ICD-10 Code *

Diagnosis Description *

CPT Code * (5 digits)

Procedure Description *

Urgency

4. Clinical Notes

Provider notes & supporting rationale *(min 50 chars)0/10000

5. AI Clinical Justification

PHI notice: Clicking “Generate with AI” sends clinical notes and diagnosis to OpenAI for processing. Do not include information beyond what is clinically necessary. Review your organization's policies before submitting patient data to third-party AI services.

6. Submission Method

✓ Pre-filled with Humana's PA fax number.