How does pre-certification work?
Before a plan participant enters a hospital or other medical facility on a non-emergency basis or receives other listed services (as defined in your plan), the patient, member or provider must contact the utilization review company by calling the number on the front of your Benesight medical plan ID card. The utilization review company will pre-certify that the inpatient service is medically necessary according to accepted medical practices. Pre-certification is not a guarantee of benefit payment by the plan.
Related Questions
- What are the pre-certification requirements for inpatient hospital confinements, maternity or residential treatment care?
- How does NMHPA affect prior authorization or pre-certification for a hospital stay in connection with childbirth?
- If a patient refuses to sign consent to release information, is a pre-certification call still required?
