Pre-Certification at Premier Health
Premier Health offers convenient and efficient pre-certification services for outpatient surgeries, inpatient surgeries, and diagnostic procedures. Premier Health System Support now provides pre-admission solutions formerly facilitated by Athena Health and Proxsys.
Premier Health’s Pre-Certification Department is pleased to assist physician offices with this process, streamlining the scheduling of tests and treatments, and improving continuity of care and patient satisfaction.
The Pre-Certification Process
Premier Health’s Pre-Certification Department is happy to obtain pre-certification and verify insurance coverage for the physician and hospital. The process is initiated by scheduling an outpatient test and surgical procedure, and usually takes two business days to process. With the exception of medical emergencies, insurers may require receipt of the paperwork from seven to 14 business days prior to the test or procedure.
Some insurers do not permit the Premier Health Pre-Certification Department to perform these duties on behalf of the physician office. We will notify your office if additional information is needed, a peer-to-peer review is requested, or a denial is received.
For more information about the pre-certification process, contact the Premier Health Pre-Certification Department.
How To Get Started
Our staff is ready to assist you with pre-certification so your patients may receive the most comprehensive, quality care possible. In our effort to establish a start date and ensure a smooth transition, we will ask your office to provide the following information:
- Contact name
- Contact position
- Phone number
- Pre-certification service requested (surgeries, diagnostics, or both)
Premier Health’s Pre-Certification Department is committed to obtaining authorization in a timely manner for the benefit of patient care. To avoid delays, we ask your practice to specify a CPT code when scheduling surgeries, and that we receive your necessary documentation at least seven days prior to the scheduled procedure (excepting medical emergencies).
For more information about getting started, contact the Premier Health Pre-Certification Department, or email Amie Hurst or Jennifer Ranly.
Same-Day and Next-Day Services
Premier Health’s Pre-Certification Department is proud to offer same-day and next-day pre-certification and scheduling. Insurers may require a minimum advance notice of services before providing authorization. A peer-to-peer review may be required in the event that pre-certification is not obtained within the required time frame. If your office wishes to obtain authorization of same-day or next-day services independently, contact us so we may avoid duplication of efforts.
For more information about same-day and next-day services, contact the Premier Health Pre-Certification Department.
Submitting Clinical Information
Premier Health’s Pre-Certification Department is committed to the efficient and confidential transfer of clinical information. We are connected to Premier Health’s Epic electronic medical record system, allowing us to swiftly acquire clinical information from practices in the Premier Epic network. Physician offices that use Epic are able to check the status of Premier Health’s pre-certification processes through this secure system.
Written clinical information may also be submitted to us by fax. We recommend that you include the following information in your written submission:
- History and physical examinations
- Rule outs
- Written clinic notes
- Results from outside radiology procedures
- Surgery posting forms
- Consent forms
- Name of the contact person in your practice
For more information about submitting clinical information through Epic or by fax, contact the Premier Health Pre-Certification Department.
Opting Out of Pre-Certification Services
If your office wishes to opt out of our pre-certification services, contact the Premier Health Pre-Certification Department or email Amie Hurst or Jennifer Ranly.
How To Reach Us
We want to make it easy for you to access our pre-certification services.
Premier Health Pre-Certification Department
Phone: (937) 499-7364, option “4”
Pre-Certification Hotline: (937) 657-3666
Fax: (937) 341-8972
Hours: 8:00 am to 5:00 pm, Monday through Friday
Premier Health Pre-Certification Department Team
Lisa Paige, Director
Jennifer Ranly, Manager
Amie Hurst, Supervisor
Stephanie McReynolds, Team Lead