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Some services, procedures, and equipment requires 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 for all Members age 9 and older.
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.
Nonparticipating providers:
Providers typically submit precertification requests on members' behalf. While not required for nonparticipating providers, it is appreciated by BCBSND members.
NOTE: The search results listed do not apply to the Federal Employee Program (FEP). Please refer to the FEP website or contact FEP Provider Services.
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.
If this is a genomic code, BCBSND contracts with eviCore for its Laboratory Management Program. eviCore in an independent company providing specific medical policy and precertification services to BCBSND. Effective 1-1-2020, Lab Management (molecular and genomic testing) is delegated to eviCore.
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.
If this is a genomic code, BCBSND contracts with eviCore for its Laboratory Management Program. eviCore in an independent company providing specific medical policy and precertification services to BCBSND. Effective 1-1-2020, Lab Management (molecular and genomic testing) is delegated to eviCore.
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
Unable to submit through Availity Essentials?
Inpatient Authorization Request
Outpatient Authorization Request
ABA Services for Autism Spectrum Disorder Supplement - This form is to accompany the appropriate authorization request
Repetitive Transcranial Magnetic Stimulation (rTMS) Authorization Request