Humana has contracted with HealthHelp to review clinical requests using an evidence-based approach. HealthHelp's innovative and collaborative program, Consult™, empowers physicians to request the most appropriate care for patients through peer-to-peer consultations for procedures/treatments, along with best practice guidelines. This informative methodology fuels sustained savings by changing long-term ordering patterns while improving patient care. HealthHelp and Humana have researched the impact of this methodology on care through their joint outcomes research program.
Notices/Announcements
ATTENTION PROVIDERS!Important Notice: Please note that as of February 1, 2024, you will no longer have the ability to fax a non-STAT authorization request. Using WebConsult is the fastest and easiest way to obtain authorizations on line. If you are not registered, please click on the enrollment link to request your online access to WebConsult.
Humana Provider Resources for Coronavirus (COVID-19)
Important Information about providing your clinical documentation. See the tutorial HERE
To initiate a procedure request online, returning users, please log in.
Not enrolled yet? To sign up, simply complete our enrollment form online. Once enrolled, our program support staff will provide your login information and access to an optional online webinar training.
Disclaimer: UM decisions are made only on appropriateness of care, services and existence of coverage as determined by the health plan. Financial incentives are not based on utilization decisions.Use the form below to check the status of a recent authorization request.
For assistance, email RCSupport@HealthHelp.com or call 1-800-546-7092 Mon-Fri 7a-7p (Central Time).
HealthHelp has developed a set of minimum criteria that providers should meet to ensure a consistent level of services. HealthHelp's Site program assesses the Facility requirements, Professional Qualifications, Equipment, and Quality and Patient Safety as part of its programs. Humana has contracted with Site to perform the assessment with the aim of achieving a quality certified network.
SITE Mission
Our mission is to identify opportunities for imaging facilities, including freestanding and physician offices, to achieve a high level of quality that benefits all members of the healthcare continuum.
The DiagnosticSite™ Assessment Program is a medical imaging safety and quality program designed to assess the medical imaging equipment, personnel, and policies of facilities that perform diagnostic imaging services.
Login to continue or update your assessment. Don’t have an account, click Register to get started!
Click here to access the Webinar.
DiagnosticSite Certification Program Help
Call us at 1-800-506-2560 or email us at SiteSupport@healthhelp.com today!
Over 29,000 facilities have participated, with more than 89,000 imaging devices assessed for quality.
Improved imaging quality produces the most consistent and efficient path to appropriate treatment and accurate diagnosis.
Humana has contracted with HealthHelp to assist in applying diagnostic imaging and interpretation criteria by clinical specialty. These criteria extend reimbursement of imaging to certain nonradiologist specialists based on the educational program requirements as listed in the American Medical Association (AMA) Graduate Medical Education Directory, medical literature and an advisory board review. These guidelines require continuing medical education (CME) credit and an associated number of supervised procedures, as well as additional education in patient safety and technique.
The diagnostic imaging and interpretation criteria provide an opportunity for reduction in both costs and medical errors, while at the same time working to improve overall quality and patient safety.
You may request additional permissible codes if you meet any of the following criteria:If you have received a notification and would like to request additional permissible codes, please click here to fill out a consideration application.
For a listing of permissible codes by modality/body, click here.
For a list of supporting articles, click here.
Physicians who have adequate training in imaging interpretation and acquisition for which they perform and bill will not experience any change in the process.
Yes. The focus is to confirm that trained health care providers are conducting and interpreting imaging studies. The health care provider must submit specific training and/or certification for performing or interpreting diagnostic imaging. Please refer the provider here or call HealthHelp at (866)-710-9155.
Specific imaging studies are CT, MRI, PET, cardiac nuclear medical studies, bone densitometry, fluoroscopy, and ultrasound.
Affected procedure codes include 70000 series excluding plain film, mammography, most interventional codes and radiation oncology; 90000 series including only vascular ultrasound and echocardiography; and corresponding select category III codes.
Radiography (“plain film,” or “x-rays”) is not overseen by Imaging and Interpretation Criteria; this will cause no change in reimbursement to physicians who bill for this modality.
Specific imaging studies are CT, MRI, PET, cardiac nuclear medical studies, bone densitometry, fluoroscopy, and ultrasound.
Upon receipt and review of documentation submitted by the physician during the consideration application process, HealthHelp’s evaluation will confirm that the organization certifying the educational activity is an accredited CME provider by searching the list of Accreditation Council for Continuing Medical Education (ACCME) and state-medical-society-accredited providers on the ACCME website (www.accme.org). The determination of the hours assigned to the program are determined by the AMA Physician's Recognition Award (PRA) credit system, which has become the CME standard for licensing boards and specialty organizations nationwide and is recognized by all U.S. jurisdictions.The sum of the hours submitted will be compared to HealthHelp’s minimum standards criteria. If the sum total of the hours submitted is equal to or greater than the minimum required, the consideration request will be approved and the health care provider will be notified of the additional permissible codes. If the sum total of the hours submitted is not equal to the minimum required, the consideration request will be denied and the health care provider will be notified of the decision and the approved permissible codes will be restated.
If a health care provider submits training hours that are not part of a formalized training program, HealthHelp will compare the information to the AMA PRA Category 2 credit requirements. For full details on those requirements, visit https://www.ama-assn.org/media/7831/download.
A: HealthHelp’s evaluation process to determine supervised procedures equivalency for training and experience will be identified through the following two components:
Upon receipt of supporting documentation, HealthHelp will make a determination on the application within two weeks. You may obtain status of your application by contacting HealthHelp at 1-866-710-9155.
For general information, contact HealthHelp at 1-866-710-9155 and a customer service representative will help you through the process.
UNAUTHORIZED ACCESS IS STRICTLY PROHIBITED
The user will be given access to information which in some cases might include individually identifiable health information, which is considered private, privileged and confidential. Such information is deemed to be Covered Information for purposes of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), P.L. 104-191. The user is required to maintain the private, privileged and confidential status of the Covered Information. The user is prohibited from further using or disclosing the Covered Information for any purpose other than the purpose for which access is granted. Please acknowledge these terms by logging in. If the user logs in, it is intended to be the legal equivalent of the user’s signature on a written document and equally binding. The user will be given access only by logging in.