WINFertility to provide prior authorization for infertility services
As of May 1, 2014, all outpatient and office infertility treatment services will require prior authorization through WINFertility. The rendering provider should contact WINFertility directly to obtain prior authorization. Please note that services rendered to diagnose infertility do not require prior authorization.
Services rendered as part of emergency room services, in the hospital inpatient setting, or in an urgent care setting at the time of the urgent care visit, are not subject to this utilization review program requirements. However, if a member receiving care in these settings is referred for infertility treatment services at a future date, those infertility treatment services are subject to any applicable program requirements.
Beginning April 15, 2014, the WINFertility call center will be available at 1-855- 255-7197 to receive prior authorization requests for infertility treatment services to be provided on or after May 1, 2014. The WINFertility call center phone number will not be active prior to April 15, 2014.
Beginning April 15, 2014, please fax prior authorization requests along with supporting clinical information to WINFertility’s Medical Management Automated Fax Request line at 1-855-255-7198. The supporting clinical information may be supplied using your own forms or clinical notes.
For any additional questions about this initiative, please contact your Network Management Consultant by calling 1-800-992-BLUE (2583) and selecting the following prompts.
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