Services Requiring Precertification

Precertification is the review we provide before you receive certain services. Without precertification, you may have greater out-of-pocket expenses. The review will also ensure that services are eligible under NJ DIRECT.

When you receive eligible services from an in-network physician, health care professional or facility, they are responsible for obtaining precertification. If you receive out-of-network services, you are responsible for ensuring precertification is obtained.

For a list of services requiring precertification, please refer to the NJ DIRECT Member Handbook.