CarePlus Health Plans Preauthorization List (PAL)
We are committed to improving the health and well-being of our members while reducing barriers to healthcare. The documents below list services and medications that require preauthorization for your patients with coverage from CarePlus.

Important information: After reviewing a preauthorization request, we will let our member, their primary care provider (PCP), and the requesting provider (if not the member’s PCP) know whether the request has been fully approved, partially approved, or denied.

 

If we deny the request, we also include information about the coverage guidelines and policies we used to make our decision.

CarePlus is a subsidiary of Humana Inc. When accessing our medical and pharmacy coverage policies, you may see Humana-branded content, as CarePlus and Humana use the same policies. You can search for medical and pharmacy coverage policies by keyword. You also can search for or sort medical and/or pharmacy coverage policies alphabetically, by effective date and/or by reviewed date.

Submitting all relevant clinical information at the time of the request will help expedite the determination. If additional clinical information is required, a CarePlus representative will contact the individual who submitted the preauthorization request and request the specific information needed to complete the authorization process.

Learn how to submit a preauthorization for frequently requested services/procedures for your patients with CarePlus coverage

Preferred Preauthorization Request Options

Skip the paperwork!

 

Check patient eligibility, submit preauthorization requests and more online. Availity offers more options and flexibility when submitting preauthorization requests. Learn more about the benefits of using Availity

 

 

Do you have questions about the Medical and Medication Preauthorization Lists or need help accessing PWS or Availity? Please call your designated Provider Services Executive or call the CarePlus Provider Operations inquiry line at 1-866-220-5448, from Monday through Friday, 8:00 am to 5:00 pm, Eastern Time. 

To prevent disruption of care, CarePlus does not require prior authorization for basic Medicare benefits during the first 90 days of a new member’s enrollment for active courses of treatment that started prior to the enrollment. CarePlus may review the services furnished during that active course of treatment against permissible coverage criteria when determining payment.