Some services, procedures, and equipment requires 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.
(No access to Availity? Complete and fax or mail the inpatient or outpatient authorization request form.)
- 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 for all Members age 9 and older.
Providers typically submit precertification requests on members' behalf. While not required for nonparticipating providers, it is appreciated by BCBSND members.
Precertification is not required:
- When BCBSND is secondary to other insurance, unless other insurance benefits have been exhausted
- For maternity admissions that result in delivery
- Medicare Supplement policies
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.