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.
References in periodicals archive ?
Any authorization holds placed on your account will automatically expire in accordance with the card issuer's policy.
The level of distinction amongst university decision makers authorizing contracts is not as important as the level of liability their authorization holds.