Precertifications for Medicaid Expansion
Some services, procedures, and equipment require precertification before the service is performed. The ordering provider is typically responsible for obtaining precertification.
- When a procedure, service or DME is ordered, use the search function below to check precertification requirements associated with the member's contract. For best results, double check the spelling or code you entered.
- If the item indicates "precertification required," submit your request through Availity Essentials.
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- If you see no results for the code or search term entered, precertification is not required. Instead, refer to the medical necessity guidelines in the BCBSND medical policy.
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.
Precertification is not required:
- Emergency/post-stabilization services and maternity admissions
NOTE: The search results listed apply ONLY to Medicaid Expansion plans.