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)

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.