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Preapproval/Precertification for Services
Commercial and Medicare Advantage Members
Certain services require preapproval/precertification from Independence Blue Cross (IBC) prior to being performed.
If your patient needs services that require preapproval/precertification, please call 1-800-ASK-BLUE. Providers registered with the NaviNet® web portal may submit requests electronically for services to be rendered at an acute care facility or ambulatory surgical center.
The Care Management and Coordination (CMC) department will evaluate your request and will notify your office once a decision has been reached for those cases that require clinical review. You will be provided with a preapproval/precertification reference number based on the determination of your request. Failure to complete required preapproval/precertification may result in a reduction in payment or nonpayment for the services not preapproved/precertified.
Your office or your patient may appeal our decision or provide additional information to support the request at any time during the evaluation process. Please refer to the CMC section of the Provider Manual for Participating Professional Providers for more information.
Services That Require Preauthorization
Employer Group Products
- Keystone Health Plan East Flex and Personal Choice® Flex
- Keystone Health Plan East Non-Flex
- Personal Choice Non-Flex
Individual and Family Products
Medically Underwritten Products
Guaranteed Enrollment Products
- Personal Choice PPO Basic I
- Personal Choice PPO Basic II
- Personal Choice PPO Value HSA
- Personal Choice PPO Hospital Care
Medicare Part B Drugs
List of Services That Do Not Require Precertification
Note: This information is updated regularly but is subject to change. For the most up-to-date information, please contact Customer Service at 1-800-ASK-BLUE. Information about services that require preauthorization can also be obtained using NaviNet.
NaviNet® is a registered trademark of NaviNet, Inc., an independent company.