MedWatch is your utilization review and case management service.
Many times your provider will obtain the certification; however, you are ultimately responsible.
MedWatch's toll-free number is on your ID card.
Call (800)432-8421 or go to www.zenithadmin.com and click on MedWatch to have services pre-certified.
Examples of services which require pre-certification- Inpatient admissions such as hospital, long-term acute care, detoxification, skilled nursing facility, hospice and extended active rehabilitation (emergency and maternity admissions do not require pre-certification).
- Surgery and other procedures such as epidural and various scope procedures, performed in an outpatient facility or the outpatient department of a hospital
- Organ/tissue/bone marrow transplants and stem cell procedures including transplant consultation or evaluation, and the transplant itself
- Home health services, home health infusion therapy and outpatient therapy services when such services are provided in the home, and continuous hospice home care
- Cancer clinical trials
As a reminder, you do not need a referral to see a specialist. Pre-certification may or may not be needed for some medical services. Contact MedWatch for specific details.