Avera Health Plans Services Requiring Pre-Certification

Sample Pre-Certification List

(Fully Insured Products)

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 pre-certification process is initiated by the Physician/Provider.

• 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 AHP Service Center Monday - Friday, 8:00 a.m. - 5:00 p.m. at 605-322-4545 or toll-free at 1-888-322-2115 CT.