Preapproval/Precertification for Services

Commercial 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 contact our Health Resource Center at 1-800-ASK-BLUE. Providers registered with NaviNet^® 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.

List of services that are subject to preapproval/precertification

• Flex Products
• Keystone Individual HMO
• Keystone/POS Non-Flex
• Personal Choice Individual
• Personal Choice Non-Flex

List of Biotech/Specialty Injectables and Infusion Therapy drugs requiring precertification

Biotech/Specialty Injectable and Infusion Therapy Drugs

Medicare Members

To review the prior authorization requirements for Medicare Advantage members, please visit www.site65.com/plan_finder/2008/eoc.html and select the Summary of Benefits for the appropriate plan.

Note: The information is updated regularly, but subject to change. For the most up-to-date information, please contact Customer Service at 1-800-ASK-BLUE, prompt 2 for Provider Services.