Azimuth Precertification

Pre-Certification Provisions/Requirements

Thank you for your cooperation in using the pre-certification process by Azimuth Risk Solutions. This article contains important information regarding the pre-certification process and requirements. Please review this information carefully, and contact us with any questions.

Specific Requirements

The following treatment and/or supplies must always be pre-certified for medical necessity by the scheme administrator:

• Inpatient treatment of any kind; and
• Any surgery or surgical procedure; and
• Care in an extended care facility; and
• Home nursing care generally; and
• Durable medical equipment; and
• Artificial limbs; and
• All covered transplant treatment.
• Diagnostic testing such as MRI, CT scan, PET scan, and Ultrasounds.

General Requirements

To comply with pre-certification requirements of this insurance for the treatment and services, the participating member or his/her physicians must:

• Contact the Scheme Administrator at the telephone numbers printed on the ID card; and
• As soon as possible before the treatment is to be obtained; and
• Comply with the instructions of the Scheme Administrator and submit any information or documents required by the Scheme Administrator; and
• Notify all physicians, hospitals and other healthcare providers that this insurance contains pre-certification requirements and ask them to fully cooperate with the Scheme Administrator

As used herein, the terms Eligible Medical Expenses, Evidence of Insurance, Medical Necessity (Medically Necessary), Physician, Scheme Administrator, Terms, Usual, Reasonable and Customary shall have respective meanings and definitions ascribed to them in the applicable policy or Evidence of Insurance (available to any insured or provider upon request).

Thank you again for your participation and cooperation in the pre-certification process. Please feel free to contact us should you have any questions, comments, or concerns.