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Precertifications
GEHA, like other federal health plans, requires precertifications.
You'll find more information on precertification in your GEHA plan brochure. For quick
reference, see your GEHA member ID card, which has two phone numbers for precertification.
If Medicare A or B pays primary benefits for these services, you do not need to precertify.
ENCOMPASS, (888) 372-3190
Call ENCOMPASS to precertify inpatient hospital stays for surgical or medical services,
physical therapy, mental health and substance abuse confinements and outpatient intensive day
treatment at in-network facilities.
You can find the ENCOMPASS website at
www.ENCOMPASSonline.com.
Although your physician or hospital will usually precertify your stay, it is your responsibility
to ensure that precertification is complete. Failure to precertify inpatient stays could
result in a benefits reduction of $500. It is not necessary to precertify hospital admissions
outside the United States. For more details on your GEHA coverage when traveling, click on
Outside the United States.
MedSolutions, (866) 879-8317
Call MedSolutions to precertify all non-emergency outpatient MRI, MRA, CAT, PET and
Nuclear Cardiology scans. Failure to precertify can result in a $100 penalty and a
review to determine if the procedure was medically necessary.
If a MedSolutions participating provider is not in your area, or if you prefer not to visit the
selected MedSolutions participating provider, you will be directed to the nearest GEHA
in-network provider for your
radiology needs.
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