As previously communicated, important changes have been made to the list of services and drugs that require precertification for dates of service on or after September 1, 2011. It is very important that providers verify member-specific requirements using NaviNet or by referring to the most current precertification requirements lists, which are available at www.ibx.com/providers/preapproval.
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. Please refer to the article in the June edition of Partners in Health UpdateSM for the complete list of changes to precertification requirements.
Note: These new precertification requirements apply to commercial members 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.