Precertification Requirement Changes for Medicare Advantage HMO and PPO Members

Effective for dates of service on or after January 1, 2012, we will implement important changes to the list of services and drugs that require precertification for Medicare Advantage HMO and PPO members. For a complete list of these changes, please refer to the October edition of Partners in Health Update^SM.

As we proceed through this transition, it is very important for providers to continue to verify member-specific requirements using the NaviNet^® web portal. Failure to obtain precertification for any of the services or drugs that require it may result in a reduction in payment or nonpayment for the services not precertified.

Note: These changes were originally announced in the June edition of Partners in Health Update and went into effect for commercial products for dates of service on or after September 1, 2011.