Providers can check the benefits summary on a member's account to see if a procedure requires pre-certification. If pre-certification is required, the summary will list the phone number to call under the line item "Pre-certification Contact" on the first page.
Additionally, we recommend that providers read through the "Special Notes by Benefit Category" below the "Pre-certification Requirements" section for the procedure type in question. Some procedure types have unique exceptions, including
pre-certification recommendations rather than requirements, different rules, or a different pre-certification contact for a specific procedure than the one listed under the line item "Pre-certification Contact".
Once a pre-certification is submitted, it can take an unknown number of days to complete. A letter of authorization or denial will be mailed once the decision is made.