Important information: After reviewing a preauthorization request, we will let our member, their primary care provider (PCP), and the requesting provider (if not the member’s PCP) know whether the request has been fully approved, partially approved, or denied.
If we deny the request, we also include information about the coverage guidelines and policies we used to make our decision.
When accessing our Medical and Pharmacy Coverage Policies above, you can search for medical and pharmacy coverage policies by keyword as well as sort policies alphabetically and by effective or reviewed date. Because CarePlus is a subsidiary of Humana, Inc. and follows the same coverage policies as Humana, you may see Humana-branded content.
Submitting all relevant clinical information at the time of the request will help expedite the determination. If additional clinical information is required, a CarePlus representative will contact the individual who submitted the preauthorization request and request the specific information needed to complete the authorization process.
Preauthorization Request Options
Skip the paperwork!
Availity Essentials™ offers more options and flexibility when submitting preauthorization requests.
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Availity Essentials:
Check patient eligibility, submit preauthorization requests and more
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CarePlus Provider Web Services (PWS):
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Other Request Submission Options
Submit via fax:
Health Services Preauthorization Form PDF opens in new window Submit via phone: CarePlus Health Services Department: 1-800-201-4305
Do you have questions about the Medical and Medication Preauthorization Lists or need help accessing Availity? Please call your designated Provider Services Executive or call the CarePlus Provider Operations inquiry line at 1-866-220-5448, Monday to Friday, 8 a.m. to 5 p.m., Eastern time.
To prevent disruption of care, CarePlus does not require preauthorization for basic Medicare benefits during the first 90 days of a new member’s enrollment for active courses of treatment that started prior to the enrollment. CarePlus may review the services furnished during that active course of treatment against permissible coverage criteria when determining payment.
