Dropping Prior Authorization

Revised Pre-certification Listing

As referenced in the direct-to-physician mailing dated 8/11/99 from Health Services Management (HSM), HNE has revised the list of services that require pre-certification. The chart below shows the non-emergency, elective procedures and specified services that require prior approval from HNE. The requesting physician should be in contact with HSM Department with requests for these services. Additions to the list include Remicade, Synagis and outpatient Hyperbaric Oxygen Therapy.

The following procedures or services no longer require precertification:

• ENT procedures for Adenoidectomy, Tonsillectomy, Tonsillectomy & Adenoidectomy,
  Bilateral Myringotomy & Tympanostomy Tubes
• OB/GYN procedures for Abdominal Hysterectomy & Artificial Insemination
• Other procedures for Bunionectomy, Eyelid & Brow
• Medications: Betaseron, Ceradase, Neupogen, Nicotine Patches & Pulmozyme
  

HNE continues to require prior authorization of elective inpatient admissions, hospice services, referral to out-of-area (affiliated specialty hospitals & staff) or out-of-plan (non-participating) specialists and mental health services. For pregnant members, the obstetrician can submit either the American College of Obstetricians and Gynecologists (ACOG) Antepartum Record Form or Obstetrical Pre-registration Form.

New Authorization Request Form

The form providers use to request prior authorization has changed. The new form is called an Authorization Request Form. Call HNE’s Customer Service Department to request copies.