MedicaidPrior AuthHigh impact
Opioid Utilization Program - Morphine Milligram Equivalent (MME) edits (Revised)
Humana·OK · Pain Management, Oncology, Palliative Care +3 more·Medicaid
Effective date
Apr 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicaid Oklahoma now requires prior authorization for all opioid prescriptions exceeding 90 morphine milligram equivalents (MME) daily. Providers must meet specific clinical criteria including documentation of failed non-opioid therapies, risk assessments, and monitoring plans to obtain approval.
Action Required
Immediately: Billing team must update prior authorization processes for all opioid prescriptions exceeding 90 MME daily for Humana Medicaid Oklahoma members. Providers must document clinical criteria including failed non-pharmacologic/non-opioid therapies, risk factor reviews, naloxone counseling, opioid use disorder evaluation, pain treatment plans, and monitoring plans. Update encounter forms and EMR templates to capture required documentation elements. Claims without proper prior authorization will be denied.