preauthorization

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preauthorization

(prē'aw-thōr-i-zā'shŭn),
A prerequisite, often intended as a rate-limiting or cost-containment step, in the provision of care and treatment to an insured patient. A practitioner who expects to be paid for a service must use paperwork and telephone contact with a designated entity (often clerks, but sometime medical professionals), often a TPA, to determine whether the proposed treatment or procedure is deemed medically necessary for the health and welfare of the covered party.
See also: benefit, health maintenance organization, managed care, fee-for-service insurance, traditional indemnity insurance.

preauthorization

Managed care The requirement by an HMO that a costly surgery, specialist referral or non emergency health care services be approved by the insurer before it is allowed. See HMO.

pre·auth·or·i·za·tion

(prē'awth'ŏr-ī-zā'shun)
In the U.S., authorization of medical necessity by a primary care physician before a health care service is performed. A referring health care provider must be able to document why the procedure is needed. It does not guarantee coverage.
See also: assignment

pre·auth·or·i·za·tion

(prē'awth'ŏr-ī-zā'shun)
In the U.S., authorization of medical necessity by a primary care physician before a health care service is performed. A referring health care provider must be able to document why the procedure is needed. It still does not guarantee coverage.

preauthorization,

n 1. the approval of or concurrence with the treatment plan proposed by a participating dental professional before the provision of service. Under some plans, preauthorization by the carrier is required before certain services can be provided.
n 2. a statement by a third-party payer indicating that proposed treatment will be covered under the terms of the dental benefits contract. See also precertification and predetermination.
References in periodicals archive ?
The NSA authorization holds a lot of weight with us since our company founders are ex-military," said Susan Jabbusch, Vice President of Carolina Advanced Digital.

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