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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 $1.99 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.

Submission checklist

○Your name, date of birth, member ID

○Your situation described (min 50 chars · 0 entered)

✓Insurer fax number

○AI appeal letter generated & reviewed

1 of 4 checks complete

Prior Authorization Request

1. Your Doctor's Information(optional — helps strengthen your appeal)

Doctor Name

NPI (10 digits)

Practice / Clinic Name

Doctor Phone

Doctor Fax

2. Your Information & Insurance

Patient Name *

Date of Birth * (MM/DD/YYYY)

Member ID *

Group Number

3. Clinical Details(optional — include if known)

ICD-10 Code (if known)

Diagnosis (if known)

CPT Code (if known)

Denied Treatment / Procedure

Urgency

4. Your Medical Situation

Describe your situation in your own words *(min 50 chars)0/10000

Explain why you need this treatment, what your doctor has recommended, and what happened when the insurer denied it. The more detail you provide, the stronger your appeal.

5. AI Appeal Letter

Privacy notice: Clicking “Generate with AI” sends your description to OpenAI to draft your appeal letter. Do not include sensitive information beyond what is medically relevant.

6. Submission Method

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