Effective for dates of service on or after September 1, 2011, we will implement important changes to the list of services and drugs that require precertification. These changes are intended to achieve consistency across product lines with regard to certain precertification requirements as we continue to look for ways to improve and simplify the precertification process.
The new precertification requirements will apply to all commercial products for dates of service on or after September 1, 2011; Medicare Advantage HMO and PPO members will transition for dates of service on or after January 1, 2012.
Providers will continue to have access to the most current lists of precertification requirements on our website. Providers also can log into the NaviNet® web portal and view each member’s Benefit Snapshot, which includes a member-specific list of requirements. It is very important for providers to use NaviNet to verify member-specific requirements as we proceed through this transition. 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.
Read the complete article in the June edition of Partners in Health UpdateSM.