Intravenous Iron Products (Revised)

REQUIREMENTS: Before submitting claims for IV iron products to Humana (Medicare or Medicaid in KY, SC, VA), the billing team must: (1) Verify all prior authorization requests for Feraheme, ferumoxytol, Injectafer, Monoferric, and ferric carboxymaltose include documentation of prior therapy failure, contraindication, or intolerance to Infed or Venofer; (2) For Medicare Part B continuation requests within 365 days of prior approval, flag as continuation therapy to bypass step therapy requirement; (3) Update prior authorization submission templates to require documentation of patient's iron studies, body weight (for dosing verification), and indication (iron deficiency anemia, CKD, or heart failure); (4) Train billing and clinical staff that approval duration follows plan year or is determined by clinical review—requests must be resubmitted annually or when clinically indicated; (5) Route all IV iron authorization requests through www.humana.com/PAL for applicable coding information; (6) For Medicare Part B claims, ensure claims will be denied without evidence of step therapy completion or documented continuation therapy status. Failure to submit complete prior authorization with step therapy documentation will result in claim denials and delayed payment.