Starting Jan. 1, 2026, CMS requires health plans to provide decisions on standard prior authorization requests within 7 days, making complete documentation at the time of submission especially important.
Humana providers submitting outpatient Medicare prior authorization requests through Availity Essentials must include the supporting clinical documentation with their request, although some exceptions may apply.
Humana has also introduced an enhanced prior authorization workflow through Availity Essentials for diagnostic imaging in Georgia, North Carolina, South Carolina, and Virginia. The updated process is designed to provide faster decisions and, in some cases, real-time approvals.