What is the process to get precertification?
Check with your doctor or other health provider to confirm who will take care of the precertification.
To complete the precertification process, please follow these steps:
- Make sure the service is covered by the plan, that the patient is a covered member of the plan and whether precertification is needed. Your plan administrator, insurer or Third Party Administrator can verify this for you.
- See the Member ID Card for the number to call for precertification.
- When you call, you will be asked a series of questions. You will receive a referral number that you can use to enable us to quickly locate your information for any future discussion if needed.
- We are often able to give approvals over the phone. If we need more information to complete the review or if one of our nurses and/or Medical Directors needs to be involved in the review, we let you know during the call.
- We complete reviews within 7 to 14 business days once we have all needed information. If you need a review completed more quickly, please let us know when you call. We will do our best to accommodate you.
- Once we have decided medical necessity, HealthSpan will advise the provider and plan administrator (TPA or insurance company).