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Avera Health Plans Services Requiring Precertification

Sample Precertification List

For many of our insured members, the following services must be pre-approved by Avera Health Plans Medical Management within five working days prior to the schedule services being rendered by calling 1-888-605-1331 or faxing to 1-800-269-8561. For emergency services you may call as soon as reasonably possible. The precertification process is initiated by the physician or provider.

NOTE: Please refer to your benefit plan to identify what you are required to get precertified. Click on Member Login. After you login, you will have access to your plan coverage. Below is a sample list of what you may find required to get precertified before having the procedure or being admitted:

  • Inpatient Hospital Admissions
  • Inpatient Alcoholism and Chemical Dependency Treatment
  • Inpatient Mental Health Services
  • Organ Transplants
  • Bone Marrow Transplants
  • Consideration of In-Network Benefits for Out-of-Network Care (except emergency and urgent care)
  • All Mayo Health Systems Referrals (for consideration of in-network benefits)

To verify benefits, please contact our Service Center at 605-322-4545 or toll-free at 1-888-322-2115, 8:00 a.m. to 5:00 p.m. CT, Monday through Friday.