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.