Yes, pre-notification is required prior to some treatments and services.
Members or providers must pre-notify Impact for any of the following treatments to be eligible for sharing:
• Cancer treatment
• Elective cardiac procedures
• Inpatient/outpatient surgery
• Non-emergency hospital/facility admission
• Organ/tissue transplant services• Maternity
Providers must pre-notify by calling (855) 378-6777. In the event of emergency/urgent care, the member or provider must provide notification within 72 hours of when medical care was given. Pre-notification of medical treatment and/or service does not guarantee eligibility or Sharing.
Pre-notification enables Impact to inform the member of provider options and potential incentives.
If a member or their provider does not pre-notify Impact of the illness, condition, treatment, procedure or event, the member will be subject to an additional provider fee of $1,000.