Certain Tuality Employee Plan services require a preauthorization to be deemed medically necessary and covered under Tuality’s medical benefits....
As a provider, you are responsible to understand what services require authorization and ensure that you have obtained the authorization prior to services being rendered. Failure to obtain the preauthorization can result in services not being covered. Please see the plan booklet for further information.
Prior to a planned hospital admission or surgery, you must call Innovative Care Management to request "pre-admission certification". Pre-admission certification is required to ensure services will be covered under the plan. In a medical emergency, members may be admitted to an inpatient facility without preauthorization, but the facility must contact Innovative Care Management on the next business day after the admission. Additional days of inpatient care, beyond those initially authorized, must also be preauthorized by Innovative Care Management.
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Website: www.innovativecare.com »