Services that require precertification* or authorization ...

D (3/17) health precertification list Services requiring precertification */authorizationBehaviora l health Services requiring precertification / authorization **This applies only to Services covered under the member s benefits plan. Inpatient admissions Residential treatment center (RTC) admissions Partial hospitalization programs (PHPs) Intensive outpatient programs (IOPs) Psychological testing Neuropsychological testing Outpatient detoxification Applied behavior analysis (ABA) Transcranial magnetic stimulation (TMS) (effective November 1, 2016) * The term precertification means the utilization review process to determine whether the requested service or procedure meets the company s clinical criteria for coverage.

**Precertification requirements apply unless state law expressly dictates otherwise. As of January 1, 2019, the following services no longer require precertification or authorization: intensive outpatient, outpatient detoxification (ambulatory withdrawal management) and …

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