When do I need to apply for a pre-eligibility review?
Pre-eligibility enables Impact to inform the member about provider options.
Providers are required to check for pre-eligibility 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), not to include x-rays or ultrasounds
Providers must request a pre-eligibility review by calling (855) 378-6777 or online.
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.
*This is not required for those in the Senior program.