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Precertification
Some benefit plans include precertification requirements for certain outpatient procedures and procedures that require a hospital stay. Two outpatient review program options are available from MedCost: Advanced Imaging and Comprehensive Outpatient Review. If a member’s benefit plan includes any precertification requirements, it will be indicated on the member’s ID card.
Please consult the member’s ID card for precertification requirements.
- If the member has advanced imaging precertification requirements, all elective CT, MRI, and PET scans should be pre-certified.
- If the member has comprehensive outpatient review precertification requirements, several outpatient services and surgeries/procedures, along with advanced imaging (all elective CT, MRI, and PET scans), should be pre-certified. A complete list of Comprehensive Outpatient Review Services is located at www.MedCost.com/CompOPR.
For members with MedCost listed as the precertification contact on the back of the ID card, you can submit and manage precertification requests electronically.
Note: Precertification is not a guarantee of payment.