Each year, the medical directors at Independence Administrators review the
list of medical services and drugs that require precertification under
Independence Administrators plan members? medical plans. They consider provider
practices, evidence-based medicine, current standards of care, technology
changes, and utilization trends. On April 1, 2016, the updated list of
services and medications that require precertification will take effect for
Independence Administrators plans. This list will be available on the
Independence Administrators website under "Procedures and
medications that require precertification."
Coordination of precertification
requests
Some of the services or supplies on the precertification list may not be
covered by a particular Independence Administrators plan member?s medical
benefits. When you request precertification, Independence Administrators
applies the benefits as defined in the Independence Administrators plan
member?s medical plan documents.
It is important that you request required precertification on your
Independence Administrators plan member?s behalf. You can request
precertification through Independence Administrators in one of the following
ways:
- Submit the request electronically through iEXCHANGE®.
- Call the number on the Independence Administrators plan member?s ID card.
Independence Administrators will apply the specified benefit reduction as
described in the medical plan if an Independence Administrators plan member
receives a covered service or supply without the required precertification.
Independence Administrators will not precertify or authorize items that the
Independence Administrators plan member?s plan does not cover. For
precertification of behavioral health services, please contact Magellan
HealthCare, Inc., an independent company, at the phone number on the plan
member?s ID card.
How this may affect prescription drug
benefits
Independence Administrators uses this list solely to administer medical
benefits. If an Independence Administrators plan member has a prescription drug
program through FutureScripts®, an independent company,
the drugs on the medical precertification list are not covered under
their prescription plan. However, some medications on the Independence
Administrators medical precertification list may be covered through other
pharmacy benefit managers? programs.
If you have questions about this update to Independence Administrators?
Health Utilization Management program or the updated precertification list,
please contact Independence Administrators Provider
Relations.
Magellan Healthcare, Inc., an independent company,
manages mental health and substance abuse benefits for most Independence
members.
FutureScripts and FutureScripts Secure are independent
companies that provide pharmacy benefits management services.