Is a pre-eligibility review required prior to seeking treatment for a medical condition?

Yes, a pre-eligibility review is required prior to some treatments and services.

Pre-eligibility is required for any of the following treatments
to be eligible for sharing:

• Cancer Treatment
• Elective Cardiac Procedures
• Non-emergency inpatient/outpatient surgery
• Organ/Tissue Transplant Services
• Maternity
• Imaging: MRIs and Nuclear Imaging (i.e. PET scans)

3-5 business day notice required, expedited review
on a case-by-case basis. Medical records are required
to determine pre-eligibility and failure to provide requested
records for review will result in the bill being
ineligible for sharing.

Providers may request pre-eligibility by calling (855)
378-6777 or online.