ANNOUNCEMENTS:

Acentra Health has partnered with the NASI Welfare Fund and NAS Metal Trades Welfare Fund to provide utilization and case management services, including optional pre-service evaluations. These evaluations assess the likelihood of whether a contemplated service meets the Plan’s medical necessity standards and other coverage requirements, while supporting participants in receiving high-quality care in the most appropriate setting and with the most effective use of services. Such advance determination is not required. However, it may be advisable to use this non-binding and free service. In making medical necessity determinations, Acentra Health may apply InterQual® Criteria, Milliman Care Guidelines®, or other nationally recognized, evidence-based clinical criteria.

We strongly encourage you to obtain an optional pre-service evaluation for the following services:

• Inpatient Services
• Intensive Outpatient Services
• Surgical Procedures
• Diagnostic Testing
• Skilled Nursing Facility (SNF)
• Durable Medical Equipment (DME)
• Private Duty Nursing
• Long-Term Acute Care (LTAC)
• Home Infusions
• Hospice
• Therapies (Physical, Speech, Occupational)

If your service is not listed above, you may still request an optional pre-service evaluation. An optional pre-service evaluation is not a guarantee nor denial of benefits. If the evaluation is negative, you are still free to obtain the service and submit a claim to the Plan, which will be evaluated based on, among other things, the information submitted in support of the claim.