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Providers must obtain precertification for certain items and/or services when required

November 7, 2017

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As an important reminder, certain procedures, services, items, and specialty drugs require preapproval/precertification from Independence prior to being rendered to or performed for our members. Failure to obtain required preapproval/precertification may result in a reduction in payment or nonpayment to the provider for the services or drugs not preapproved/precertified by Independence.

New denial notification procedure

Independence has discontinued sending letters to notify providers of denials for procedures, services, items, and specialty drugs due to of lack of preapproval/precertification within the specified time frame.

Instead, denial notifications due to lack of preapproval/precertification within the specified time frame will be communicated to providers via telephone. The denial decision is final, and there will be no opportunity to appeal. Note: This does not apply to denials for medical necessity.

Resources

For your convenience, we maintain comprehensive preapproval/precertification lists that outline the procedures, services, items, and specialty drugs that require preapproval/precertification. These lists are available online for Independence commercial and Medicare Advantage members.

In addition, a supplementary document, Services Requiring Precertification, is available and includes the CPT® and HCPCS codes, where applicable, that correlate with the procedures, services, items, and specialty drugs on the Preapproval/Precertification List. For your convenience, there is a link to this document included on the Preapproval/Precertification List.

You can also access Services Requiring Precertification by visiting our Medical Policy Portal and selecting Accept and Go to Medical Policy Online. Then select the Commercial or Medicare Advantage tab from the top of the page. From there, select Services Requiring Precertification from the left-hand menu.

CPT Copyright 2016 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.

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