Medicare AdvantagePrior AuthMedium impact
Corifact® (Factor XIII Concentrate [Human]) (Revised)
Humana·KY · Hematology, Pharmacy, Pediatrics·Medicaid
Effective date
Dec 17, 2025
We identified it
Jun 25, 2026
Summary
Humana revised its Corifact® (Factor XIII Concentrate [Human]) prior authorization policy for Kentucky Medicaid and Medicare effective December 17, 2025. The policy clarifies coverage is limited to patients with congenital Factor XIII deficiency for routine prophylactic treatment or peri-operative management of surgical bleeding, requiring prior authorization. Billing teams must ensure all Corifact claims include proper diagnosis coding and prior authorization before submission.
Action Required
By December 17, 2025: Billing team must implement prior authorization requirements in billing software for all Corifact intravenous solution claims. Before submitting Corifact claims, verify: (1) Member has documented congenital Factor XIII deficiency diagnosis, (2) Indication is either routine prophylactic treatment (administered every 28 days) OR peri-operative management of surgical bleeding, (3) Prior authorization is obtained and attached to claim. Update encounter forms and provider templates to include diagnosis verification for Factor XIII deficiency. Claims submitted without prior authorization will be denied. Route all Corifact requests through PAL system at www.humana.com/PAL for claim code information.