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.

If Medicare A or B pays primary benefits for these services, you do not need to precertify.

To check benefits and eligiblity, call GEHA's Customer Service department at (800) 821-6136.

How to precertify an admission
The following information provides guidance regarding who you, your representative, your doctor or your hospital must call prior to admission to a facility.

Hospital precertification

Mental health hospital or intensive outpatient services for mental health, substance and alcohol abuse

If you have an emergency admission due to a condition that you reasonably believe puts your life in danger or could cause serious damage to bodily function, you, your representative, the doctor or the hospital must call us within two business days following the day of the emergency admission, even if you have been discharged from the hospital.

Although your physician or hospital will precertify your stay, it is your responsibility to ensure that precertification is complete. Failure to precertify inpatient stays could result in a benefits reduction. 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.

Other services requiring precertification
Skilled nursing facility, long-term acute care facility, rehab facility

Outpatient physical therapy, occupational therapy, speech therapy

How to precertify a radiology/imaging procedure
For outpatient CT, MRI, MRA, NC and PET studies, you, your representative or your doctor must call MedSolutions before scheduling the procedure. The toll free number is (866) 879-8317. For the state of Georgia, call Coventry Health Care of Georgia at (800) 470-2004. For the states of North Carolina and South Carolina, call WellPath at (800) 708-9355. For the state of Pennsylvania, call Health America Pennsylvania at (800) 755-1135.

You'll need to provide the following information: patient's name, plan identification number and birth date, requested procedure and clinical support for request, name and telephone number of ordering provider, and name of requested imaging facility.

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.