Pre-certification List

The list of services below will need to be pre-certified in advance of having the service performed. The pre-certification number is 866-729-0127.

You may also pre-certify online at hinesassoc.com. Click on Online Referrals at the top of the page, then click on Utilization Review, complete the form and submit.

• In-patient hospital medical/surgical
• Out-patient surgical procedures
• Durable Medical Equipment (DME) over $500.00
• Rehabilitation services (Physical/ Occupational / Speech)
• Chemotherapy / Radiation Therapy
• Home Health Care
• Hospice
• Skilled Nursing Facility
• Magnetic Resonance Imaging (MRI)
• CAT Scans
• Sleep Studies
• Bone Density Studies
• Muscle Conduction Studies
• Outpatient Psychiatric/Substance Abuse Treatment
• Inpatient Psychiatric/Substance Abuse Treatment
• Transplants
• All Services or procedures over $1000.00

Failure to pre-certify the services listed above will result in a reduction in benefits for services which are determined to be medically necessary. There will be no benefit for services determined not to be medically necessary.

If you have questions please contact Customer Service at 715-478-7448.