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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.
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