How is the insured's medical procedure or treatment reviewed?
1. IMG's Precertification Program reviews the medical necessity and, for inpatient
admissions, the anticipated length of stay using national standards and guidelines.
2. Each case is reviewed separately. Most of the certification requests IMG receives are
handled on the first review by the Case manager.
What happens to cases that do not meet national guidelines?
1. A small percentage of certification requests do not meet national guideline standards.
These cases will be referred to IMG's Medical Director for further review.
2. Notification of the outcome will be sent via telephone, fax or letter to the insured and
physician (or hospital) after the review is complete.
CONTINUED STAY REVIEW
When is continued stay review necessary?
1. Continued stay review is performed for all insureds who remain in the hospital beyond
what IMG had originally certified.
2. Continued stay reviews are initiated by IMG or the hospital. This will occur on the day
the insured is scheduled to be discharged from the hospital. IMG contacts the physician
or hospital to determine whether discharge is planned as scheduled, or additional day(s)
and continued stay review will be necessary.
3. The continued stay review continues until the insured has been discharged. Please note,
Continued Stay Review follows the same procedures as Precertification Review.
What qualifies as a medical evacuation?
1. The definition may vary somewhat by plan, but generally must be an immediate threat
to life or limb.
2. The treating physician must concur the medical evacuation is warranted.
What is the process for medical evacuation reviews?
1. Like Precertification, these are reviewed on a case by case basis, but evacuation requests
always take first priority due to their serious nature.
2. Generally, are to the nearest appropriate medical facility.
IMPORTANT INFORMATION TO KNOW
1. IMG is available at the following times: 24 Hours a day, 7 days a week for emergencies
7:00 a.m. to 6:00 p.m. (EST) for non emergency precertification and general questions.
2. The website may be used for non urgent Precertification requests.
3. Failure to precertify may result in a reduction of benefits and additional penalties.
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