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What is precertification request?

Prior authorizationsometimes called precertification or prior approvalis 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 a prior authorization Aetna?

There may be a time when you have a health problem that cant be treated by your primary care physician (PCP) alone. Sometimes you may need specialty care or to see a specialist. Prior authorization PDF Opens In New Window is a request to Aetna for you to get special services or see a specialist.

What is prior authorization for medication Aetna?

We call this prior authorization. Sometimes we may call it precertification or preapproval. These all mean the same thing. Its the process of confirming if your plan will cover a certain service or prescription drug.

What does it mean to need a prior authorization?

A prior authorization (PA), sometimes referred to as a pre-authorization, is a requirement from your health insurance company that your doctor obtain approval from your plan before it will cover the costs of a specific medicine, medical device or procedure.

What are the most common ways that prior authorization can be performed?

These steps are usually done manually, often through a cascade of phone calls, faxes and emails between payer and provider. The responsibility falls on the provider to continue to follow up with the insurance company until there is resolution of the prior authorization request an approval, redirection, or denial.

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What is the difference between 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.

Does Aetna require preauthorization?

Some care will require your doctor to get our approval first. This process is called prior authorization or preapproval. It means that Aetna Better Health of California agrees that the care is necessary for your health.

What is the process of a prior authorization?

Prior authorizationsometimes called precertification or prior approvalis 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 purpose of a precertification?

Prior authorization (also called preauthorization and precertification) refers to a requirement by health plans for patients to obtain approval of a health care service or medication before the care is provided. This allows the plan to evaluate whether care is medically necessary and otherwise covered.

How long does a preauthorization take to release?

A pre-authorization (also pre-auth or authorization hold) is a temporary hold on a customers credit card that typically lasts around 5 days, or until the post-authorization (or settlement) comes through.

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What is precertification request?

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What is the difference between precertification and preauthorization?

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