What is pre-authorization or pre-certification?


Pre-authorization or pre-certification is a process completed by Conifer Health Solutions, the Trust’s Utilization Management Vendor.  Certain services covered by the Plan require this process (like Hospitalizations, Continued stays at an Inpatient Facility, and some outpatient services).  

If your employee’s (or their family member’s) Physician recommends they or a covered family member be hospitalized, the participant must contact the Utilization Management Vendor for assistance with the certification process. Hospitalizations out of the country or when this Plan is the secondary payer do not require pre-certification. All other hospitalizations require pre-certification prior to an elective or planned hospitalization or the next business day after an urgent or emergency admission. To obtain pre-certification for an admission, the participant can call Conifer Value-Based Care at 877-687-9527.

When they call, they should have their Medical ID number, Employer name, patient name, home phone number, and physician name and phone number ready.  

Notification may be initiated by the employee, a family member, their Physician, or a representative from the hospital. The Utilization Management Vendor will review the Physician’s recommendations based on the medical information supplied and accepted standards and criteria for hospital admission. In most cases, the Utilization Management Vendor will notify the employee or family member, their doctor, and the hospital of the certification approval within 24 hours. (For hospitalizations, the hospital will be advised of the number of approved days when Conifer provides certification approval).