What is Precertification and Why Do I Need It?

What is Precertification and Why Do I Need It?
September 9, 2021 Laura Dziomba
What is precertification?

When your doctor orders health care services, it helps to have someone else on your side to make sure you’re getting the right care, for the right length of time, in the right setting. This is where precertification comes in.

Precertification is an important process that helps ensure your very best health outcomes, while also helping you save on the cost of your care. Definitely important topics on most peoples’ minds these days!

How does it work?

In some instances, your doctor will call to precertify some services that are beyond your standard doctor’s visit. This might include a hospital stay, specific surgerys that can be done in a hospital or doctor’s office, certain diagnostic treatments and procedures and continuing care services. When your doctor calls, a team of medical professionals will review your treatment plan against standard quality of care guidelines. Then, they make sure this service is medically necessary. To read more about what services require precertification under your health care benefits plan, consult your benefits guide.

Some services you may need to precertify:

    • Before admission to the hospital for elective or non-emergency services.
    • Within 48 hours (two working days) after an emergency or urgent hospital admission.
    • Before elective inpatient, outpatient or ambulatory surgery.
    • Before inpatient substance-abuse treatment for a mental health disorder.
    • Before entering an extended-care, rehabilitation or skilled-nursing facility.

If your plan has issued you an ID card, you can probably find the phone number you’ll need to precertify your care. If not, contact the Customer Service number of your health care plan to learn more. Precertification is just another way to help you and your family stay safe and healthy. It helps safeguard your finances by making sure you get the proper care from the right providers.


Want to learn more? 

Want to learn more about precertification? Just check out our video. You can also visit the Meritain Health YouTube channel! You’ll find videos on topics like precertification, plus many other topics to help you understand and use your health care benefits.



If you have a Meritain Health benefits plan and have any questions, we’re here to help. Just call our  Meritain Health Customer Service team at 1.800.925.2272. If you have any questions about precertification, just call our Meritain Health Medical Management team at 1.800.242.1199.