precertification
Prior approval required
Precertification is approval required by an insurance company before a medical procedure, hospital stay, or treatment will be covered.
The process confirms that the proposed care is medically necessary and eligible for benefits: The surgery requires precertification from your insurer.
Without it, patients risk having claims denied or paying out of pocket.
State of meeting criteria
- coverageExtent of inclusion
- authorizationFormal permission granted
- preauthorizationPermission obtained beforehand
- benefitsGains or helpful effects
claims · policyholder · deductible · premiums · reimbursement · co-pay · underwriting · exclusions
Favorable opinion given
- documentationWritten proof or instructions
- paperworkAdministrative written tasks
- verificationProving something accurate
- requirementsNecessary conditions for something
process · compliance · procedures · forms · submission · review · criteria · screening
Prescribed sequence of actions
- treatmentCare for an ailment
- surgeryInvasive medical procedure
- hospitalizationFormal entry into medical care
- specialistExpert in one field
referral · imaging · MRI · diagnostic · inpatient · outpatient · elective · urgent
eligibility
State of meeting criteria
- coverageExtent of inclusion
- authorizationFormal permission granted
- preauthorizationPermission obtained beforehand
benefits · claims · policyholder · deductible · premiums · reimbursement · co-pay · underwriting · exclusions · denial
approval
Favorable opinion given
- documentationWritten proof or instructions
- paperworkAdministrative written tasks
- verificationProving something accurate
requirements · process · compliance · procedures · forms · submission · review · criteria · screening · checklist
procedure
Prescribed sequence of actions
- treatmentCare for an ailment
- surgeryInvasive medical procedure
- hospitalizationFormal entry into medical care
specialist · referral · imaging · MRI · diagnostic · inpatient · outpatient · elective · urgent · physician
- utilization reviewprior authorization, preauthorization, medical necessity, clinical guidelines, approval
precertify, precertified, certification, certify, certified, certifying, certifiable, certificate, certificates