What is precertification or prenotification, and when is it needed?
Consult your benefit booklet or contact the customer service number on your ID card to determine if you are subject to precertification or prenotification prior to certain medical services. Precertification is the requirement to contact the local Blue Cross and Blue Shield plan serving the area where the services will be rendered before being admitted to a hospital for inpatient care or within two business days following an emergency hospital admission. It is your responsibility to ensure that precertification is obtained. You, your physician or the hospital must contact our precertification vendor (Access Health) at 1-800-451-7302. If precertification is not obtained and benefits are otherwise payable, benefits for the admission will be reduced by $500. Precertification is not needed for in-state, in-network inpatient admissions. Precertification is not needed for maternity admissions unless your medical condition requires you to stay more than 48 hours after a vaginal delivery or 96
