What happens if a Humana member receives outpatient therapy without an authorization?
Any claim submitted for services, other than the initial evaluation, which does not have a valid authorization, will be subject to financial penalties for the practice and the member, based upon the providers contract and the members Certificate or Evidence of Coverage. Additionally, services provided without preauthorization may be subject to retrospective medical necessity review. All providers, both participating and non-participating, will be required to pre-certify additional therapy services under this program.
