A requirement that you obtain the insurance company's approval before a medical service is provided. If you fail to follow the pre-certification procedures the company may reduce or deny claim payment.
Also known as pre-admission certification, pre-admission review and pre-cert. They also describe the process of obtaining authorization from the health plan for routine hospital admissions (inpatient or outpatient). Often involves appropriateness review against criteria and assignment of length of stay. Failure to obtain pre-certification often results in a financial penalty to either the provider or the subscriber.
a review by Intracorp to determine if a scheduled service or admission is medically necessary and meets any notification requirements of the Plan.
an approval that you receive for a
Utilization management program that requires the individual or provider to notify the insurer before hospitalization or surgical procedure. Notification allows the insurer to authorize and to recommend alternate courses of action.
Applies to specified services that require review and approval prior to the expense for such services being incurred. If a service is not Pre-Certified, benefits paid for that service will be reduced in accordance with the provisions of your Certificate of Insurance or Evidence of Coverage.
Insurance companies require pre-approval of non-emergency hospital admission and certain surgical procedures to verify necessity and appropriateness. Pre-certification is a part of all health plans today.
Review processes that verifies the medical necessity and appropriateness of proposed services or supplies.
A requirement under the plan to have all non-emergency hospital admissions approved in advance.
(also called Utilization Review) - Requires an insured to obtain the insurance company’s approval before a medical service is provided. If the insured fails to follow the pre-certification procedures, the company may reduce or deny claim payment. Getting pre-certification does not guarantee claim payment.
Pre-admission review and approval of appropriateness and medical necessity of hospitalization or other medical treatment.
In order to assure that you will receive the fullest coverage, certain plans require you to report in advance any non-emergency surgery, procedures and/or hospitalizations you will undergo. Some plans may require immediate notification, even in an emergency. Without this certification, you may not receive maximum coverage for care provided.
an insurance company requirement that an insured obtain pre-approval before being admitted to a hospital or receiving certain kinds of treatment.
The prior approval needed from the Health Plan before receiving certain non-emergency, outpatient health care services. In some contracts, it is the member's responsibility to obtain pre-certification. Be sure to check your Evidence of Coverage or Group Certificate and any associated riders and endorsements for more details.
Through Chickering’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 Chickering has determined that the procedure your physician recommends is medically necessary. Pre-certification also confirms that Chickering 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.
Also known as pre-admission certification, is the process of obtaining authorization from the health care plan for routine inpatient and outpatient admissions. Failure to obtain pre-certification may result in penalty to the provider or the subscriber.
is also known as "prior-authorization" or "pre-admission review." The process of pre-certification is determining the justification of certain procedures such as inpatient or outpatient surgery, diagnostic tests or physical therapy.
Requirement of your insurance company to determine medical necessity for service rendered. Pre-certification does not guarantee benefits for payment.
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.
Review of “need” for care before admission. This review determines whether or not your insurer will pay for the service.
Advance approval from the insurance company required to receive mental health benefits. Pre-certification is obtained by the member or provider contacting the insurance company.
The approval an insurance company must give before hospitalization or surgical procedure. Notification allows the insurance company to authorize and to recommend alternate courses of action. The goal is to unnecessary non-emergency procedures.
The process of notification and approval of elective inpatient admission and identified outpatient services before the service is rendered.