Frequently Asked Questions about precertification


What is precertification?

Precertification is a determination by your health plan that the recommended medical service, supply or drug meets the definition of medical necessity under your plan. Precertification must be done prior to you receiving the recommended medical service, supply or drug. The definition of medical necessity can be found in the Definitions section of your benefit booklet.


Who initiates the precertification process?

In some cases, your provider will handle the process for you. You should check with your provider to see if he or she has received precertification. It is your responsibility to ensure that you or your provider gets precertification.


What services require precertification?

Please see your benefit booklet to determine what services require precertification under your plan. If your benefit booklet refers you to for additional precertification requirements, the following services or supplies require precertification under your plan:


  • Alabama in-network radiation therapy services


Are there any prescription medications that required precertification?

Yes, precertification is required for certain prescription drugs. You can find a list of the drugs that require precertification in the Prescription Drug Guide. This list will be updated monthly. For precertification, call the Customer Service Department number on the back of your ID card.