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HumanaMedicare Advantage · Prior Auth · Newsletter · IN, KY, LA, OH, OK, SC, VA · Cardiology, Endocrinology, Geriatrics +4 moreHigh impact

Humana Physician News: Q2 2026

Effective date
Jul 1, 2026
Identified
Nov 1, 2026

Summary

This Q2 2026 Humana newsletter (published April 1, 2026, discovered November 1, 2026) contains multiple effective dates spanning past, ongoing, and future actions. Key changes include: (1) New prior authorization lists effective July 1, 2026, for Medicare Advantage, Dual Eligible SNPs, and Medicaid plans; (2) Medicaid provider-administered medication PAL changes for seven states; (3) PPO members inactive since May 1, 2024, were automatically unpaneled as of March 1, 2026; (4) New claims-based attribution rules for MA products effective April 1, 2026; and (5) Published claims payment policies including a new Paper Claim Administrative Fee. The newsletter emphasizes timely prior authorization submission before services are fully furnished to avoid claim denial and retroactive authorization processing.

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What to do

Action · 13 steps
01HISTORICAL & ONGOING ACTIONS (Already Elapsed): Verify that the practice has ceased panel billing for any Humana PPO members who did not have a primary care visit since May 1, 2024—these members were automatically removed as of March 1, 2026.
02Confirm that patient rosters have been reviewed for accuracy.
03ONGOING (Effective April 1, 2026): Acknowledge that Humana implemented new claims-based attribution rules for all MA products (HMO and other MA plans) effective April 1, 2026.
04Contact ServiceFund@humana.com with questions about which patients are now assigned to your panel under the new faster attribution method.
05FUTURE REQUIREMENT (Effective July 1, 2026): Before this date, download and review the new prior authorization lists (PALs) for all affected plan types and geographies served by your practice.
06Medicare Advantage and Dual Eligible SNP PALs.
07Medicaid PALs.
08Medicaid provider-administered medication PALs if your practice serves members in Indiana, Kentucky, Louisiana, Ohio, Oklahoma, South Carolina, or Virginia.
09Billing team and front desk staff should update the prior authorization tracker and charge entry edit logic to ensure that services and medications on these lists are flagged for prior auth requests before scheduling or claims submission.
10Providers should review the updated lists and discuss with staff.
11Consult the Humana Provider Manual for specific guidance.
12Critical reminder: Per CMS rules stated in this newsletter, prior authorization requests submitted after services are fully furnished will be processed as payment (retroactive) requests and may be denied if authorization was required but not obtained.
13Submit prior auth requests before care is furnished, not as retro authorization after the claim is submitted.

Original notice

Humana Physician News: Q2 2026
assets.humana.com · Always check the source before changing claims.
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Humana policiesIN policy changesKY policy changesLA policy changesOH policy changesOK policy changesSC policy changesVA policy changesCardiologyEndocrinologyGeriatricsInternal MedicineFamily MedicineGeneral PracticeRheumatology

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