Companion Benefit Alternatives

Precertification

What is precertification?

Precertification is the process of requesting authorization for services before receiving them.  

How do I know if I need to request precertification?

Your health plan decides if precertification for services is required. You can check your schedule of benefits to see what services require it. You can also contact your health plan to see if precertification is required for the service you need. Check the back of your insurance card for the contact phone number.

When you receive services in a facility or hospital setting, the facility staff should call to get precertification for you. 

What happens if precertification is required and I do not get it?

There may be a penalty. Check your schedule of benefits to find out if your plan has a penalty.

How do I request precertification?

CBA accepts precertification requests via the phone and fax.

  • Facility or hospital services: For services you receive in a facility setting, your provider will contact CBA and get precertification for you. We encourage you to share your insurance information with your provider as soon as possible so that he or she can request precertification.
  • Changing to a different provider: If you decide to change to a different provider, please call us to close the current precertification. You can only have one certification on file at a time for each type of service. We will close the current certification and create a new one for the provider you choose.

What information is needed to process precertification requests?

We will need this information to process your request:

  1. Name, insurance card number and date of birth.
  2. Name and address of provider.
  3. Symptoms/reason for seeing provider.

What’s the difference between seeing an in-network provider and an out-of-network provider?

When you choose to see an in-network provider, you will pay a lower copayment or coinsurance. In-network providers will also request precertification for additional visits, when needed. Out-of-network providers are not required to perform this service for you.

Out-of-network providers are also not required to file claims on your behalf. They may ask you to pay for the visit in full and then submit the claim for reimbursement yourself. In-network providers will always file the claim for you and will accept your copayment or coinsurance as payment in full.