The Verification Department is responsible for relaying verbal and/or written coverage information, as needed, to Providers for members to receive medical services.
The Verification Department’s email address is firstname.lastname@example.org. In addition to faxes, etc. this site is another method of convenience for the submission of pre-certification forms and/or referral letters.
- Q.What is precertification and how do I obtain it?
- A.Precertification is the process of obtaining prior approval for services to be rendered to BahamaHealth members locally or abroad. Note: Please refer to your contract for the listing of specific items that require pre-certification.
- Usually, a member’s physician would fax (into BahamaHealth) the Company’s standard precertification form requesting approval for a named procedure. BahamaHealth’s Medical Director would subsequently review the form and follow with a decision outcome.
- Q.How long does the approval process take?
- A.Unless otherwise indicated, the normal pre-certification process takes 24-48 business hours (2 days) provided all of the required information has been supplied and in a timely manner.
- Q.What is a physician referral and why do I need it?
- A.A physician referral is:
- The act of the treating physician referring someone or something for consultation, review, or further action.
- The directing of a patient to a medical specialist by a primary care physician.
A referral letter is usually written by doctors when they refer a patient to another doctor or specialist in a particular field. A doctor should write a referral letter following a particular format, as follows:
- Specialty being referred to
- Name of provider being referred to
- Relevant medical details of patient
- Reason for referral
- Referral date
- Complete details of patient including full name, date of birth, gender, etc.
- Name and address of referring physician including phone and fax numbers
- Referral letters serve to advise BahamaHealth that the member’s physician acknowledges that the medical condition warrants specialized treatment either locally or abroad.
- Q.If I need to check on the approval of a pre-certification, how could this be done?
- A.Please contact the Verifications Department at 242-396-1303 through 6.
- Q.How do I confirm that the physician I am referred to in the USA is a network provider?
- A.You could access BahamaHealth’s U.S.A provider database by logging on to www.aetna.com. Aetna is currently our Third Party Provider (TPA). The provider network outside of the USA is also currently maintained by Aetna.
- On the left side of the page, there are 2 options: "log-in" or "register."
- If you have not registered with Aetna as yet, you will need to choose the option to register, and follow the following steps:
From here you will be asked to enter the following:
- ID# (as indicated on your AETNA ID card)
- Name (enter member’s name as it appears on your Aetna card)) - please note that this point is essential for registration. Registration access is provided for the person seeking registration. E.g. The wife must register for herself and the husband for himself.
- Date of birth
- Zip code (leave blank)
- The registration process would begin followed by a request to create a log-in and password for this account.
- Once you have registered the account, you will be brought to a page that would indicate, "Welcome (Your Name)."
- Select the option on the left that says "Doc Find"
From that point you could enter the specific parameter(s) for your intended physician(s).