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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.

What does it mean to need a prior authorization?

What is a Prior Authorization? A prior authorization (PA), sometimes referred to as a \u201cpre-authorization,\u201d 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.

How long does Aetna take to approve?

Request authorization at least 15 days before the procedure, unless it's an emergency. Use the electronic portal to submit the requests and medical records. You can request the service as soon as it is planned. We may be able to authorize up to six months for the patient to get the service done.

What happens if you don't get pre-authorization?

If you're facing a prior-authorization requirement, also known as a pre-authorization requirement, you must get your health plan's permission before you receive the healthcare service or drug that requires it. If you don't get permission from your health plan, your health insurance won't pay for the service.

What is the purpose of preauthorization?

Prior authorization (prior auth, or PA) is a management process used by insurance companies to determine if a prescribed product or service will be covered.

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What is prior authorization Aetna?

There may be a time when you have a health problem that can't 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 Aetna?

There may be a time when you have a health problem that can't 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.

Does Aetna require preauthorization?

What is prior authorization? 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 precertification 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.

Is precertification the same as preauthorization?

Sometimes called prior authorization, prior approval or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency.

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