pre-certification

Englisch - Englisch

Definition von pre-certification im Englisch Englisch wörterbuch

Requirement of your insurance company to determine medical necessity for services rendered Pre-certification does not guarantee benefits for payment Benefits are based on policy provisions in force at the time services are rendered Questions about pre-certification requirements in your contract should be directed to your insurance plan

The process of deciding whether or not BCBSKS will cover a specific service Check the health plan carefully Certain procedures, like surgery, require pre-certification This means the member needs to check with BCBSKS to see if the service is covered before it is received

Refers to certifying the medical necessity and level of care in advance Pre-certification does not guarantee that contract benefits will be available

The process in which health care professionals evaluate an attending physicians request for a patients admission to a hospital to evaluate whether or not inpatient care is necessary The health care professional involved in the evaluation process are employed by the insurance companies and/or health plans

Through Health Net’s Certification Program, you obtain approval for coverage before receiving certain types of services Pre-certification can protect you from undergoing unnecessary medical procedures and paying bills for services that the plan does not cover When you receive pre-certification, it means that Health Net has determined that the procedure your physician recommends is medically necessary Pre-certification also confirms that Health Net covers the procedure under the Stanford Student Dependent Insurance Plan If you do not obtain pre-certification, the plan reduces its payment for covered services to 50 percent

UR function that certifies the number of days a claimant will need to stay in the hospital in advance of the admission and/or procedure

- a review by Intracorp to determine if a scheduled service or admission is medically necessary and meets any notification requirements of the Plan

prior assessment by the insurance carrier that proposed services (e g , hospitalization) are medially appropriate and necessary for a member and are covered by the member's insurance plan

The prior authorization required by some managed care companies before health benefit payments will be authorized See "Authorization "

Relevante Übersetzungen

precertification

A process by which approval must be obtained before a planned admission, use of home health services, private duty nursing, hospice services, or home infusion therapy

precertification

Review processes that verifies the medical necessity and appropriateness of proposed services or supplies

precertification

The process of obtaining certification or authorization from the health plan for hospital admissions (inpatient or outpatient) or for surgery, based on the judgment of medically appropriate care by a qualified peer Failure to obtain precertification often results in a financial penalty to either the provider or the subscriber Also known as preadmission certification or preadmission review

precertification

Cost to provide the services or purchase services

precertification

A method of providing assurance to the employee or provider that the admission to an institution is a covered benefit In addition, precertificiation provides information as to the approved length of coverage Traditionally, this type of review is used for hospital inpatient admissions

precertification

Utilization management program that requires the individual or provider to notify the insurer before hospitalization or surgical procedure Notification allows the insurer to authorize payment, length of stay and to recommend alternate courses of action

precertification

authorization from a health plan for routine hospital admissions (in- or outpatient), required in advance of the proposed admission Often involves appropriateness review against criteria and assignment length of stay (LOS) Failure to obtain precertification often results in a financial penalty to either the provider or the member

precertification

An evaluation of a medical need before admission to: a hospital, or a mental health or substance abuse facility

precertification

Advance approval that is required from Blue Cross and Blue Shield of Texas

precertification

A procedure for reviewing and certifying proposed health care treatment before treatment begins

precertification

A utilization management technique that requires a plan member or the physician in charge of the member's care to notify the plan, in advance, of plans for a patient to undergo a course of care such as a hospital admission or complex diagnostic test Also known as prior authorization