The following services require certification and must be certified as medically necessary by Acentra:
Inpatient hospital admission, except routine maternity admissions
Inpatient rehabilitation
Residential treatment facility
Inpatient bariatric surgical procedures
Outpatient bariatric surgical procedures
Private duty and home health nursing
Solid organ and bone marrow/stem cell transplants
Home infusion therapy
Skilled nursing facility
Long term acute care facility
Hospice care
Diabetic self-management training/education
Acentra must be contacted in advance of any anticipated nonemergency hospital admission and immediately following an emergency admission by calling 888-801-1910. Failure to comply with notification requirements may result in financial penalties, reduction of benefits or even denial of benefits.
Note: Certification is not required for those participants having Medicare or other primary coverage, unless the service is not covered by Medicare or other primary coverage. In this case, the service will be subject to the certification process through Acentra.
This article lists the medical services that require notification and certification of medical necessity from Acentra.