Precertification

What requires precertification?

Some kinds of care in the contracted and non-contracted provider options require precertification, such as inpatient care and some outpatient procedures.  This includes using contracted providers in Hawaii for some services and procedures.  If using the Cigna PPO Network for care in non-Kaiser Permanente states (outside of CA, CO, GA, HI, MD, OR, VA, WA and DC), the Cigna PPO providers are responsible for obtaining precertification on your behalf when precertification is required. You won’t be financially responsible if a Cigna PPO provider fails to obtain precertification for covered services.

How do I receive precertification?

• Your physician, hospital, or authorized representative may obtain precertification for you.
• Contact Permanente Advantage at 1-888-529-1553 (TTY 711) and press 2 for precertification. You may request precertification 24 hours a day, seven days a week, for urgent requests.
• To learn more, visit www.kp.org/providers/kppa, or review the precertification section in your Evidence of Coverage (EOC)/Certificate of Insurance (COI) for details.
• Some kinds of care in the contracted and non-contracted provider options require precertification, such as inpatient care and some outpatient procedures.  This includes using contracted providers in Hawaii for some services and procedures.  If using the Cigna PPO Network for care in non-Kaiser Permanente states (outside of CA, CO, GA, HI, MD, OR, VA, WA and DC), the Cigna PPO providers are responsible for obtaining precertification on your behalf when precertification is required. You won’t be financially responsible if a Cigna PPO provider fails to obtain precertification for covered services.

If you don’t obtain precertification for contracted and non-contracted provider option services when required, the services may be subject to a reduction in benefits otherwise payable.  If the service is deemed not to have been medically necessary, you may have to pay the entire expense. Benefit reduced due to the application of a penalty will not apply toward your deductible and annual out-of-pocket maximum. So, it’s really important to get precertification. To learn more, review the precertification section in your Certificate of Insurance for details.