Out-of-Area Plan
Pre-certification
To ensure that the medical service ordered is medically necessary, cost effective, and the most appropriate treatment for your condition, prior approval may be required. This is known as pre-certification for services ordered by any licensed provider.
To see data regarding approvals and denials of pre-certification for both medical and pharmacy view the Disclosure Reporting for Prior Authorization Request and Exemptions.
What requires pre-certification?
Any licensed provider
- Some services require pre-certification to be covered, such as:
- Hospital admissions
- Outpatient surgeries
- Inpatient rehabilitation, hospice, or skilled nursing facility services
- MRI, CT, and PET scans
- For a complete list of services that require pre-certification, see your Certificate of Insurance (Coming Soon).
How do I receive pre-certification?
- You are responsible to obtain pre-certification. If pre-certification is not obtained, benefits payable by KPIC, will be reduced by twenty percent (20%) each time Pre-certification is required. This 20% reduction will not apply toward your deductible or out-of-pocket maximum. So, it’s important to get pre-certification.
- You or your doctor should call to ask for pre-certification before you schedule services by calling 1-855-364-3184 (TTY 711). Representatives are available Monday through Friday, 8 a.m. to 6p.m., Mountain time.
- To learn more, review the pre-certification section in your Certificate of Insurance (Coming Soon) for details. You can also visit the Permanente Advantage website.
Need pre-certification?
Call 1-855-364-3184 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m., Mountain time.