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Some services, procedures, and equipment require precertification before the service is performed. The ordering provider is typically responsible for obtaining precertification.
NOTE: Any service that is potentially cosmetic does require precertification.
NOTE: Dental anesthesia and hospitalization for dental care, precertification is required.
NOTE: Repair of a covered wheelchair does not require pre certification. Benefits are allowed for repairs of latest wheelchair that has been covered by insurance.
NOTE: The search results listed apply ONLY to Medicaid Expansion plans.
This code does not require a precertification. Medical policy may apply.
Any service that is potentially cosmetic does require precertification.
NOTE: Dental anesthesia and hospitalization for dental care, precertification is required for all Members age 9 and older.
This keyword does not require a precertification. Medical policy may apply.
Any service that is potentially cosmetic does require precertification.
NOTE: Dental anesthesia and hospitalization for dental care, precertification is required for all Members age 9 and older.
To view InterQual criteria, go to Authorizations and Referrals in Availity Essentials.
For more information visit InterQual.
Precertification required. Log into Availity Essentials.
Precertification required
Questions related to Availity Essentials
Phone: Availity Client Services at 1-800-282-4548
Monday through Friday 7 a.m. - 6:30 p.m. CST