As previously communicated in a Partners in Health UpdateSM article, as of June 1, 2019, Independence requires precertification for all non-emergent transfers from one inpatient acute-care setting to another inpatient acute-care setting and for non-emergent land and air ambulance transports.
Requesting precertification
The method for requesting precertification differs depending upon the type of service and who requests it.
For non-emergent transfers from one inpatient acute-care setting to another inpatient acute-care setting
- Facilities need to call the Independence Utilization Management team to request precertification when a non-emergent inpatient transfer request is initiated by the facility, regardless of the way the member will be transported.
- The receiving facility should obtain the precertification authorization from the transferring facility before the non-emergent inpatient transfer occurs.
- Facilities are not able to initiate non-emergent inpatient transfer requests through the NaviNet® web portal at this time.
For non-emergent ambulance transportation
- Ambulance providers should verify that the transferring facility has obtained precertification for all non-emergent ambulance transport requests through the Authorizations transaction on NaviNet. If an authorization is not found, please contact the requesting transferring facility.
- For any other elective ambulance transport requests initiated by the ambulance provider, the precertification request must be submitted through the Authorizations transaction on NaviNet.
- When non-emergent air ambulance requests are initiated by the ambulance provider, the precertification request must be called in to the Independence Utilization Management team. Providers are not able to initiate non-emergent air ambulance requests through NaviNet at this time.
Failure to obtain or verify precertification when required may result in a reduction in payment or non-payment for services rendered. Inpatient transfers, including ambulance transportation, performed on an emergency basis are still subject to post-payment review.
For more information
If you have any questions about this change, please call the Independence Utilization Management team at 1-800-ASK-BLUE.
This requirement is reflected in our updated Preapproval/Precertification List, which is available on our website.
The Billing & Reimbursement for Ancillary Services section of the Hospital Manual for Participating Hospitals, Ancillary Facilities, and Ancillary Providers will be updated to reflect this requirement.
NaviNet® is a registered trademark of NantHealth, an independent company.