What does pre cert mean?
What does pre cert mean?
1) Most commonly, “preauthorization” and “precertification” refer to the process by which a patient is pre-approved for coverage of a specific medical procedure or prescription drug.
What is the precertification process?
Prior authorization—sometimes called precertification or prior approval—is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.
What is the difference between a precertification and preauthorization?
Pre-authorization is step two for non-urgent or elective services. Unlike pre-certification, pre-authorization requires medical records and physician documentation to prove why a particular procedure was chosen, to determine if it is medically necessary and whether the procedure is covered.
What does precertification mean in health insurance?
A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification.
Is a precertification a referral?
A referral is issued by a primary care physician (PCP) for the patient to see a specialist. In contrast, prior authorization is issued by the payer (an insurance provider), giving a medical practice or physician the approval to perform a medical service.
What does a precertification specialist do?
The Precertification Specialist is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers.
Why is precertification required?
Pre-certification also known as pre-authorization is the process of obtaining approval from the travel insurance company to receive a particular medical service, treatment, or prescription drug. Pre-certification is usually required for planned medical procedures such as surgery, hospitalization, and MRI and CAT scans.
What is preauthorization in health care?
When the insurer has agreed to accept the claim in advance, this stage in cashless claims process is called pre-authorisation. The time taken to settle an insurance claim is an important factor for people buying health insurance.
Is a precertification the same as a referral?
Why is it necessary for a provider to obtain preauthorization and precertification?
For example, if an ordering physician has to obtain pre-authorization from an insurance company for the use of a particular drug, the physician must send a pre-authorization request so that the insurer can determine whether the drug is medically appropriate and safe to use before agreeing to pay.
Who is responsible for obtaining precertification for a referral to another physician or specialist?
The patient
Akin to an official recommendation, referrals are made from one physician to another. The patient is usually responsible for obtaining the original referral from their doctor. Following the request, the physician may simply write a script for treatment that references a specific doctor, such as a specialist.
