Precertifications and Prior Authorizations

Precertifications and prior authorizations are required for most medical procedures, medications, behavioral health services, home health care, durable medical equipment, and certain imaging services to ensure necessity and coverage. Key requirements include verifying the patient's current coverage and benefits, as well as providing documentation that confirms medical necessity. Notably, emergency services do not require precertification, but any non-compliance with precertification processes may result in denied coverage for those services.

"Medical procedures require precertification to ensure necessity and coverage."

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