Pre-certification
Pre-certification is required for all services; however, ValueOptions® shall permit Members to self-refer (i.e. access services without prior authorization) under the following circumstances for Covered Services: Members shall be able to access all outpatient services without a referral up to a pre-specified initial authorization limit when the KCPC is completed and submitted by the provider. In addition, social detoxification services, and any service for any woman who is pregnant or has dependent children, can be accessed without a referral up to a pre-specified initial authorization service limit when the KCPC is completed and submitted by the provider. For services above that limit, Members shall obtain prior authorization.
