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What is a precertification letter?

Prior authorizationsometimes called preauthorization or precertificationis 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 does pre-certified mean for health insurance?

Pre-admission certification also called pre-certification review, or pre-admission review refers to the fact that many health plans require a member to receive approval from the health plan before receiving non-emergency inpatient care.

What are precertification requirements?

During the precertification process, medical professionals review the planned medical services against standard medical criteria to ensure that the services are within accepted medical standards and are medically necessary. Precertification may be initiated by you, your representative or your medical provider.

What steps are needed to obtain precertification?

To obtain precertification, one should call the provider services number, provide procedure and diagnosis details to the insurer, and document the call in the patients health record.

What is difference between precertification and preauthorization?

Pre-Certification vs Pre-Authorization 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.

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