Medicare AdvantagePrior AuthHigh impact
Intravenous Iron Products (Revised)
Humana·KY, SC, VA · Hematology, Oncology, Internal Medicine +3 more·Medicaid
We identified it
Jul 15, 2026
Summary
Humana has revised its Prior Authorization policy for Intravenous Iron Products affecting Medicare, Medicaid - Kentucky, Medicaid - South Carolina, and Medicaid - Virginia members. This 1-day-old policy update requires immediate review to identify specific authorization requirements and any billing workflow changes needed for IV iron infusion claims.
Action Required
IMMEDIATELY: Billing team must access the full policy document at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a57d238 to extract specific CPT/HCPCS codes for IV iron products and detailed prior authorization requirements. Update billing system to enforce prior authorization for affected IV iron codes before submitting claims to Humana. Configure system alerts for the three affected Medicaid states (KY, SC, VA) and Medicare plans. Train front desk and clinical staff on new authorization procedures. Claims submitted without required prior authorization will be denied. Verify authorization requirements differ by state and plan type before claim submission.