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Precertification requirement changes and updated lists available in July

July 1, 2011

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As announced last month, we will implement important changes to the list of services and drugs that require precertification effective for dates of service on or after September 1, 2011. The updated precertification requirement lists will be available in July at www.ibx.com/providers/preapproval.

The following precertification requirements will be added for all commercial products in all settings:

  • potentially cosmetic procedures (please refer to the June edition of Partners in Health Update for the complete list);
  • pain management procedures (paravertebral facet joint injections, transforaminal epidural injections, epidural injections);
  • hyperbaric oxygen treatments;
  • additional medical infusion/injectable drugs (please refer to the June edition of Partners in Health Update for the complete list);
  • cataract surgery;
  • cochlear implant surgery;
  • uvulopalatopharyngoplasty (UPPP or UP3).

The following precertification requirements will be removed for all commercial products in all settings:

  • sleep studies
  • cardiac rehabilitation
  • pulmonary rehabilitation

As we proceed through this transition, it is very important for providers to continue to refer to the most current precertification requirements list or to use NaviNet® to verify member-specific requirements. Failure to obtain precertification for any of the services or drugs that require it may result in a reduction in payment or nonpayment for the services not precertified.

Please call 1-800-ASK-BLUE if you have any questions about these upcoming changes.

Note: These new precertification requirements will apply to all commercial products for dates of service on or after September 1, 2011; Medicare Advantage HMO and PPO members will transition for dates of service on or after January 1, 2012.

NaviNet? is a registered trademark of NaviNet, Inc., an independent company.

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