Companion Benefit Alternatives

Precertification 101

What is precertification?

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

How do I know if I need to request precertification?

A member’s health plan benefits determine if you must get prior approval for services. In many cases, if the health plan requires precertification and you do not get it, the health plan may reduce or deny your reimbursement.

You can contact the health plan to get benefit and eligibility information. If you have created a profile, you may also get this information on our health plan partners’ online provider resource tool.

How do I request a precertification?

CBA accepts precertification requests via the Web, fax and phone.

You can request precertification online through our secure Form Resource Center. All providers can use this tool whether or not they are in our network. CBA gives priority processing to requests submitted through the Form Resource Center.

If you have a profile to use our health plan partners’ online provider resource tool, you can instantly get your precertification any time of day. Here you will be able to check eligibility, benefits and precertification requirements. It's available to you 24 hours a day. (This tool does not apply for members of the Federal Employee Program or PAI plans.)

To request precertification by fax, please complete the appropriate form. If you fax your request to CBA, keep a copy of the faxed confirmation for your records.

To make a request by phone, please contact CBA during our regular business hours. To avoid delays, please have the member’s health plan information available and select the appropriate prompts.

How do you process a precertification?

Once we receive the request for precertification, our clinical staff begins processing the request. Here are the steps we use:

  1. Verify member eligibility, benefits, exclusions, parity, etc.
  2. Verify provider status (contracting/non-contracting).
  3. Confirm necessary demographic and clinical information to process the precertification.
  4. Generate certification if services are approved.
  5. Communicate the certification status and information to the provider.

How will I receive the certification?

After we process your request, we will give case-specific information to both you and the member. We will respond using the same method you used to submit the request.