precertification

English - English

Definition of precertification in English English dictionary

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

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

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

Cost to provide the services or purchase services

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

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

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

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

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

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

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

Hyphenation

pre·cer·ti·fi·ca·tion