What is the difference between precertification and pre-notification? 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 pre-notification prior to certain medical services. Preadmission certification or precertification is a process where a member must call and receive prior approval for an admission into any hospital. Failure to receive preadmission certification usually involves a penalty payment by the member of a specified dollar amount – varies by plan design. Arkansas Blue Cross and Blue Shield no longer requires preadmission certification. Pre-notification is a process where a member should call in prior to admission to an out-of-network hospital facility or a hospital outside the state of Arkansas to alert us of the admission. Pre-notification provides information helping to determine if case management would be an appropriate option for the member. Pre-notification is not required for outpatient treatment or any in-state, in-network inpatient admissions. If y
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