Pre-Authorization and Pre-Certification

The healthcare provider needs to obtain pre-authorization for any planned inpatient hospital admission. You may need to precertify certain outpatient surgical procedures and other medical services. The services you must pre-certify are specified in the participant's benefit documents. Verification of eligibility and benefits is the responsibility of the provider and the participant. Please provide the ICD-9 and CPT-4 codes that are associated with the requested medical treatment or surgical procedure.