Authorizations/Precertifications HDHP, Standard and High Option members

Important note: The authorization information on this page is for GEHA's HDHP, Standard, and High plan members. For other medical plans, visit Authorizations/Precertifications for Elevate and Elevate Plus members.

General information

• Authorization requirement: GEHA, like other federal health plans, requires providers to obtain authorization before some services and procedures are performed.
• Reference: More information can be found in the GEHA plan brochure. For quick reference, see the GEHA member's ID card.
• Clinical guidelines: The sources of our clinical guidelines can be found on our Sources of Utilization Management Criteria (PDF).
• Primary payer: If Medicare or another group health insurance policy is the primary payer for these services, you do not need to obtain authorization.

Emergency admissions
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:

• Action required: You, your representative, the doctor, or the hospital must call GEHA within two business days following the day of the emergency admission, even if you have been discharged from the hospital.
• Responsibility: Although your physician or hospital will precertify your stay, it is your responsibility to ensure that precertification is complete.
• Failure to precertify: Failure to precertify inpatient stays could result in a benefits reduction.
• International admissions: It is not necessary to precertify hospital admissions outside the United States. For more details on your GEHA coverage when traveling, click Outside the United States.

Contact information

• Benefits and eligibility: Call GEHA's Customer Care department at 1-800-821-6136.
• Prior authorization: Refer to the back of the patient's ID card under the heading Prior Authorization for the appropriate contact information and submission.