Precertification FAQs

Precertification FAQs 

 

How can I complete a precertification request for two or more procedures — such as a colonoscopy and endoscopy — via My Insurance ManagerSM? You are unable to complete a precertification request for more than one service on a single entry using My Insurance Manager. Once you have chosen your request type and select one service, you will continue through the remaining precertification request screens to completion. At that time, you may begin a second request.

How can I have diagnoses added to the Fast-Track Request Option in My Insurance Manager? Contact Provider Relations and Education to have a diagnosis-procedure combination considered for adding to the Fast-Track Request Option in My Insurance Manager.

At times when I call the Plan to get a DME precertification, I’m told the member’s plan does not require an authorization for the item. However, when the claim is filed it is denied for no authorization. Why? Always verify benefits and eligibility to find out if an item requires precertification. Generally, an authorization number is required for DME supplies over $500.

How can I edit the default diagnosis code when requesting a precertification for a procedure via the Fast-Track Request Option? Users are unable to edit the diagnosis code when using the Fast-Track Request Option; this may be done via the Customized Authorization Request Option. My Insurance Manager defaults to a standard diagnosis for Fast-Track Request Options but it does not prevent the requestor from gaining an authorization number.

Can I go directly to Novologix to complete a precertification request? No, you cannot go directly to the Novologix portal. There is only single sign-on access through My Insurance Manager using the member’s ID.