If you have questions regarding pre-certification requirements for any member for any of our products,
please call the customer service number on the back of the member's ID card.
Admission Pre-certification — The process of evaluating the appropriateness of an admission against established medical necessity criteria and assignment of initial length of stay at the time of admission into an acute care facility or at the time of notification by the facility of the member’s admission.
Continued Stay Review — The process of evaluating the appropriateness of continued inpatient stay during the inpatient confinement.
Admission Pre-notification — Notification of the hospital admission only. No medical necessity review is required.
Outpatient Pre-certification — The process of evaluating the appropriateness of an outpatient procedure/service against established necessity criteria.
Necessity Criteria — Approved criteria, which includes nationally recognized medical necessity review criteria.
back to manual home | next
Arkansas Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association and is licensed to offer health plans in all 75 counties of Arkansas.
Copyright © 2001-2017 Arkansas Blue Cross and Blue Shield