Is Precertification Required?

The term "precertification" means the medical review process that determines whether the requested service, procedure, drug or medical device meets clinical criteria and is medically necessary and appropriate. Precertification is considered the first step in the benefit process. The claim administrator then applies all other terms and conditions of the benefit plan once the claim is received. This includes any exclusions and the member’s eligibility on the date of service. Precertification alone is not a guarantee of benefit payment.

Sentinel strives to maintain the most current precertification requirements for each group it services. In the event of discrepancy between the plan document or policy and the guidelines herein, the plan document or policy will control.

For all plans and policies, precert IS NOT required for required for: X-rays, CT scans, MRIs, Blood work, ER visits unless admitted to hospital, Psychiatric counseling, or Chiropractic treatment.

Precert Search

Enter a Member ID and Group No to determine if a service or procedure requires precertification

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