Humana military prior authorization form 2026

1. Click ‘Get Form’ to open the humana military prior authorization form in the editor.
2. Begin with SECTION I: PATIENT INFORMATION. Fill in the patient's last name, first name, middle initial, date of birth, address, city, state, zip code, sponsor's SSN, sponsor's name, and phone number.
3. Proceed to SECTION II: OTHER HEALTH INSURANCE. Enter the policy holder's name, policy ID number, carrier name, effective date, and carrier phone number. Indicate if service is approved by other health insurance.
4. In SECTION III: PROVIDER INFORMATION, provide details about the primary care manager (PCM) contact person and the specialty referred to. Include facility name, contact person’s phone number and fax number.
5. Complete SECTION IV: REFERRAL/AUTHORIZATION INFORMATION by selecting the appropriate services needed such as evaluation only or inpatient admission. Specify any surgical procedures or equipment required.
6. Fill out SECTION V: CODES with ICD 9 diagnosis codes or CPT codes relevant to the patient's condition.
7. In SECTION VI: CLINICAL INFORMATION, attach any necessary documentation that supports medical necessity. Indicate if additional information is submitted and provide service date if known.
8. Finally, complete SECTION VII: ANTICIPATED DISCHARGE NEEDS by checking all applicable options for post-discharge requirements.

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