Introduction

A Prenotification is required prior to specific medical treatments, which are outlined in the Solidarity HealthShare Sharing Guidelines. This information is submitted to our Care Coordination Department who performs a medical review of the requested service. Listed below is a link to the sharing guidelines for more information, as well as the list of services that require a Prenotification and all the information required to submit a Prenotification to Solidarity HealthShare.   

 For detailed information on pre-notifications, please reference the Solidarity HealthShare Sharing Guidelines.

All Services That Require Pre-Notification:

• Alternative or Integrative treatments including but not limited to naturopathic treatments, or allogenic stem cell therapies
• Home Health Care
• In-Home Hospice Care
• Imaging: MRI and Nuclear imaging
• Inpatient services including hospital admissions, skilled nursing, inpatient medical rehabilitation, hospice
• Maternity and Fertility Services
• Organ/Tissue Transplant Services
• Prosthetics
• Sterilization Reversals
• Surgeries both inpatient and outpatient, but NOT in-office surgeries
• Genetic Testing

Required Information for Pre-Notification:

All the following information is required to comlete the pre-notification process. Please have the information ready prior to filling out this form. 

1. Member Name
2. Member Email Address
3. Member Date of Birth
4. Membership ID Number
5. Provider Name
6. NPI Number 
7. Provider Address
8. Provider Phone Number
9. Provider Fax Number
10. Facility Name
11. Facility Phone Number
12. Facility Fax Number
13. Date of Service 
14. ICD-10 Code
15. CPT Code
16. Clinical Notes
17. *LMP (If Maternity Pre-Notifcation)
18. *EDD (If Maternity Pre-Notification)
19. *Statement of Conception (If Maternity Pre-Notifcation)

 

Clinicals / Medical Record Requirements

• In order to make a determination on a pre-notification, clinicals detailing medical necessity must be sent to Solidarity HealthShare. 
• For a Maternity pre-notification, the clincials must contain the LMP (Last Menstrual Period) or EDD (Estimated Date of Delivery), as well as a the statement of conception form.
• To send clinicals to Solidarity HealthShare, you can uploaded them below, or sent in via fax (844-306-1023) or email (info@solidarityhealthshare.org).

Please reveiw your responses to make sure they are accurate before submitting your pre-notification.

Member Name: {MemberFName}

Member Email: {membersEmail}

Membership ID: {membershipId}

Provider Name: {providerName}

Provider Address: {providerAddress}

Phone Number: {providerPhone}

Fax Number: {providerFax}

Facility Name: {facilityName}

Facility Phone Number: {phoneNumber}

Facility Fax Number: {facilityFax}

Date of Service: {dateOf}

ICD-10 Code: {icd10diagnosis}

CPT Code: {cptprocedure}

 

 

For any questions about submitting your pre-notificiation, please reach out to the Member Care Team through your Member Care Portal or by calling (844) 313-4999.