A pre-eligibility review is required before some treatments.
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.