Precertification list change notification July 1, 2023

The following services will be added to precertification for the effective dates listed below:

• Precertification responsibility: The ordering or rendering provider of service is responsible for completing the prior authorization process.
• HMO plans: Services that require precertification will be denied if rendered without the appropriate prior authorization for in-network providers. HMO members may not have benefits for non-emergency services rendered outside of the network and are subject to review and may be denied.
• PPO plans: Precertification for services requiring prior approval is highly recommended. If not completed in advance, a pre-payment review of the claim will occur and may result in a denial of claim reimbursement.
• EPO plans: Precertification for services requiring prior approval is highly recommended. If not completed in advance, a pre-payment review of the claim will occur and may result in a denial of claim reimbursement. No out of network benefit is available, with the exception of emergency department/urgent care and authorized services.

To request precertification with the Virginia plan, access Availity Essentials* availity.com:

• For maternity, medical, and surgical precertification, call the number listed on the back of the member’s ID card.
• For mental health and substance use precertification, call 800-755-0851. Professionals are available 24 hours a day, seven days a week.