This is a reminder that important
changes to the list of services and drugs that require precertification are in
effect for Medicare Advantage HMO and PPO members for dates of service on or
after January 1, 2012.
The following
precertification requirements have been added for Medicare Advantage products
in all settings:
- potentially cosmetic
procedures (please refer to the complete list in the October 2011 edition of
Partners in Health UpdateSM);
- pain management procedures
(i.e., paravertebral facet joint injections, transforaminal epidural
injections, epidural injections);
- hyperbaric oxygen
treatments;
- additional medical
infusion/injectable drugs (please refer to the complete list in the October
2011 edition of Partners in Health Update);
- cataract surgery;
- cochlear implant surgery;
- uvulopalatopharyngoplasty (UPPP or
UP3).
The following
precertification requirements have been removed for Medicare Advantage products
in all settings:
- sleep studies
- cardiac rehabilitation
- pulmonary
rehabilitation
It is very important that providers
continue to refer to the most current precertification requirements list or to
use the NaviNet? web portal 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.
NaviNet® is a registered trademark of
NaviNet, Inc., an independent company.