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21 11/2005
Outpatient Services Requiring Pre-certification
• Arthroscopy – shoulder/knee
• Biofeedback
• Gastric Obesity Surgery
• Home Health Skilled Nursing
• Hysterectomy (Age < 35)
• Orthognathic/TMJ
• Reconstructive Surgery
• Sleep Studies
• UPPP
• Transplant Evaluations – Call 1-866-694-0724 or Fax
1-888-896-8679
Effective January 1, 2006 the Following Procedures Will Require Pre-certification
• EMG/Nerve Conduction Studies
• Epidural/Facet Injections for Pain Management
The following group numbers have special requirements (revised 4/04/2006):
• kochcel, kochcer, kochcob, kochfhr, kochinv,
kochmin, kochret – Inpatient Services Only
• 1023553, 1023551, 1023552 – Inpatient
Services and Home Health Care Services
• husqvar – Inpatient Services, Group Specific
Outpatient Services, Home Health Care, DME
and Transplants
• * 1002814 – Inpatient Services, Group Specific
Outpatient Services, Home Health Care and
Transplants. Specific List by CPT Code, contact
Customer Service
• * bor0030, bor0090, bor0120, bor0180, bor0210, bor0240, bor0270,
bor0280, bor0300, bor0330, bor0360, bor0390, bor0400, bor0420,
bor0430, bor0450, bor0480, bor0500, bor0510, bor0540, bor0570,
bor0610, bor0620, bor0630, bor0690, bor0700, bor0710,
bor0720, bor0730, bor0750, bor0760, bor0810, bor0840, bor0870,
bor0890, bor0930, bor0980 – Inpatient Services, Group Specific
Outpatient Services, Home Health Care, Hospice and Transplants.
Specific List By CPT Code, contact Customer Service.
• * ga90324, ga90127, ga90126, ga90124 – Inpatient Services,
Group Specific Outpatient Services, Home Health Care and
Transplants. Specific List By CPT Code, contact Customer Service
* Mental health and substance abuse services are provided by WellPoint
Behavioral Health
Pre-certification/ Pre-notification Process for BSBSGa
• Submit all required clinical information 15 calendar days before the proposed procedure when possible. A minimum time
frame of three business days is required to complete a thorough clinical analysis. A pre-certification number will be
provided to you once all clinical information has been received and reviewed.
• Institutional Admissions – All facilities must notify us within 24 hours or the next business day (whichever is earlier) after
admission.
Pre-certification requests can be submitted as follows:
Routine Requests
Fax ........................................................1-877-254-4971 (PAR/PPO) 404-842-8390 or 1-888-246-0226 (HMO/POS)
Phone ........................................................1-800-722-6614
Emergent / Urgent Phone............................1-800-722-6614
National Imaging Associates (for CT, CTA, MRI, MRA, PET Scans and Nuclear Cardiology) ......1-866-642-9704
Mental health and substance abuse services 1-800-292-2879 .............. Fax 1-877-868-7950
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