Is pre-eligibility required?
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.