How to Begin the Pre-Authorization/Pre-Certification Process

Physicians should begin the pre-authorization or pre-certification process by calling our Utilization Management at least 72 hours prior to the participants admission to the hospital or receipt of other medical services requiring pre-certification. Our Utilization Management is available 24 hours at 1-800-962-0643. Physicians will be asked to provide the following information:

• Patient’s name and date of birth
• Insured’s name, group number and Social Security number
• Physician’s name and telephone number
• Diagnosis
• Scheduled admission date (if applicable)
• Hospital name (if applicable)

A registered nurse will review the information provided by your physician to be sure that the proposed medical care is both medically necessary and appropriate. You will be notified in writing that the planned inpatient admission has been pre-authorized or a proposed service has been pre-certified. Please make sure that our Utilization Management is contacted to obtain all required pre-authorizations or pre-certifications. It is your responsibility to make sure that OneNet has pre-authorized any planned inpatient admission or pre-certified other designated services. Failure to obtain required pre-authorization or pre-certification could result in claim denials b the payor.