Passport has complied a database of pre-certification rules which identify the necessary pre-certification requirements for specific payers. Each payer has its own rules, most of which are not easily available to a provider, dictating the health care services that require pre-certification.

The pre-certification requirement is used by most payers in an effort to contain costs and is being applied to a greater number of clinical procedures. Lack of pre-certification remains one of the top five reasons for claim denial.

Passport’s rules have been collected from numerous sources at each payer, including their website, and is updated as the payer changes, adds or deletes its pre-certification information.

When a pre-certification form is required, Passport also presents the form and methods of authorization.

Benefits of the pre-certification rules database

• Accommodates frequently changing, complex rules that vary from payer to payer
• Significantly reduces the time to identify and authorize pre-certification
• Reduces lost revenue from denials, penalties and costly appeals due to lack of pre-certification

Download pre-certification rules database PDF    Pre-certification rules database payer list