Precertification Process

Please note that precertification vendors and requirements vary by plan.
 

1. Determine Precertification Requirements. Prior to submitting a precertification request, please verify precertification requirements and where to send your request. You can do this by:

    • Calling the Provider Services or Precertification phone number listed on your patient’s member ID card. Refer to the ID card examples to the right.
    • or Visiting Access Patient Benefits, open the patient's Summary Plan Description, and navigate to the Schedule of Benefits for precertification information.

Note: if you have verified that HPI AchieveHealth provides precertification services, you may reference the Precertification List in the drop-down below.

2. Submit a Request. Submit a precertification request to the appropriate Utilization Management vendor from the options listed below.

For HIPAA verification, please be sure to provide the correct spelling and date of birth for the member prior to submitting your request.

Due to high call volume, please FAX all requests for precertification to 508-756-1382. Requests submitted via the online portal will not receive a response if the service does not require precertification.
Please remember to check the precertification list to determine if precertification is required prior to submitting. 

Print or Download HPI's Precertification Form


AchieveHealth Precertification List
 

medical form iconComplete a Precertification Request Online


Click here to view the list of drugs that do not require precertification when given with chemotherapy.

 

Molecular Genetic Testing, performed by Carelon Medical Benefits Management


Effective June 1, 2024, HPI’s molecular diagnostic testing program is delegated by HPI to Carelon Medical Benefits Management (Carelon). The program reviews for the following services.

  • Pharmacogenomics and thrombophilia testing
  • Neurogenetic and neuromuscular testing
  • Tumor markers
  • Hereditary cardiac testing
  • Hereditary cancer testing
  • Reproductive carrier screening
  • Prenatal testing
  • Rare disease testing
  • Whole exome/genome sequencing
  • Please note: Cytogenetics/Cytopathology testing CPT codes 88104-88299 should be submitted to HPI directly for review.

Providers should submit authorization requests through the Carelon portal at www.providerportal.com or by telephone at 833-607-1729.

  • Call: 877-687-9527