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We abide by nationally recognized, evidence-based treatment guidelines and medical policies for authorization decisions.
Precertification of OFFICE VISITS for an established patient with a work-related injury is not required. This does not apply to pain management, mental health services, dentistry, or similar type service. Please contact our Customer Service Department for any inquiries at 410-494-2000 or 1-800-264-4943.
Select one of the form options below:
We encourage all medical providers to use our convenient and secure online eServices to request precertification authorization. If you do not have an eServices account with us, you can create one here. Please note that you will need your vendor number and FEIN in order to create an account. Upon submitting an eServices precertification request, you will be provided a reference number and a fax number for supplying supporting documentation when necessary. Please include this reference number and the claim number with all documentation you forward to us.
Online eServices
Login or create an account with us.
Access the appropriate fillable form below, complete it by typing in your information, and email the completed form to our Precertification Department. Be sure to save a copy for your records. You may also print and fax the completed form to 410-494-2079. Submitted requests will be reviewed in the order in which they are received.
Submitting precertification requests online benefits both you (the provider) and Chesapeake Employers in numerous ways:
Only online eServices requests provide a confirmation that the precertification request has been received. Any precertification requests that are sent via fax or email will not receive confirmation automatically.
The review process begins when all necessary information is received. We strive to meet the following timeframes:
Once an authorization determination is made, it is faxed using the fax number that is submitted on the precertification request.
Creating an eServices account only takes a few minutes! You can create your account here or if you already have an account, you can login here.
If you have multiple employees within your practice that need access, they can each create their own individual account and password.
To check on the status of submitted requests please contact our Customer Service Department at 410-494-2000 or 1-800-264-4943.
Medical Policies are evidence-based in considering what is reasonable, medically necessary, and non-investigational or experimental medical treatment. These policies assist us in making utilization and authorization decisions.
