Mercy Managed Care
Prior Authorization and Pre-certification Information
The starting point for determining pre-authorization requirements is always the back of the patient’s insurance card. The information that follows is meant to be helpful, but it is not all inclusive or exhaustive.
Aetna (2008)
- Medical Precert List
- Behavioral Health Precert List
CIGNA
Register for a user ID and password.
Enter them. Press “enter’ and you will be at the precertification information page.
Coventry Prior Authorization Quick Guide
Look for “Prior Authorization Quick Guide” under the Provider Information column.
Or, copy/paste this web address into your browser to go directly to the page:
http://www.chciowa.com/content/items/13972/CMLMCD PA Quick Guide 0308.pdf (effective 3-1-08)
For Coventry’s outpatient surgeries that don’t require prior authorization:
http://www.chciowa.com/content/items/13907/OPSurgAuthNotReqd010106.pdf
John Deere (UHC of the River Valley) Copy/paste these web addresses into your browser.
- Procedures https://www.uhcrivervalley.com/preauthorization/procedures.html
- DME https://www.uhcrivervalley.com/Preauthorization/Durable_Medical_Equipment.html
- Prescription Drugs https://www.uhcrivervalley.com/Preauthorization/Drugs.html
- Other Services https://www.uhcrivervalley.com/Preauthorization/Other_services.html
Preferred Health Choices (Health Choices)
- E-mail from Dawn Jaeger, 6-18-07
At this point, Health Choices has two groups within our area. Each of the groups has differing Pre-Certification Requirements. The two groups are Iowa Mold & Tooling and the Diamond Jo - Worth County. For each of the groups I have listed below the pre-certification requirements.
Iowa Mold & Tooling
- Durable Medical Equipment & Supplies (purchased or rented) with a reimbursement of $300 or more per item.
- Hospitalizations or Medical Care Facilities Stays, including those for Substance Abuse/Mental Disorder treatments.
Diamond Jo - Worth County
- Non-emergency hospital admissions.
- Emergency admissions within 48 hours of admission.
- Nursing Facility Services.
- Home Health Services.
- All Mental/Nervous and Substance Abuse Treatment.
- Hospice and Respite Services.
- Diabetic Counseling.
- Durable Medical Equipment & Supplies (purchased or rented) with a reimbursement of $300 or more per item.
- Home Infusion Therapy.
- Outpatient Physical, Occupational, or Speech Therapy.
The pre-certification forms are available online at (registration is required)
United Healthcare
- Radiology Notification Program Overview:
- Radiology Notification Program Protocol:
- Radiology Notification Program – List of CPT codes included
- Standard Notification Requirements
Wellmark
Please contact Kristi Larsen at 641.422.6986 with any questions/comments regarding this web page.