preauthorization

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 ?
Moreover, EMR, insurance reports, quality-control reviews, and prescription preauthorization requests have mightily taxed physicians and their staff.
A proposal for payers to cover larger, more comprehensive NGS cancer panels with preauthorization under circumstances of extenuating medical need; and
Our flight coordinators work directly with insurance providers to manage the insurance approval process, and handle the preauthorization for transportation and individualized medical needs for patients.
com)-- Infinx Services, a leading provider of technology-enabled revenue cycle management solutions had recently signed a large contract on medical preauthorization service and proudly announces successful delivery of pre-authorization solutions to one of the largest radiology groups in the United States.
Nonradiologist utilization of American College of Radiology Appropriateness Criteria in a preauthorization center for MRI requests: Applicability and effects.
Under the program, echocardiography management (which required clinical review and preauthorization for any echocardiography tests performed in outpatient settings according to widely accepted clinical guidelines) was added to previously existing management of other cardiac imaging tests, including CT, MRI, PET, and nuclear medicine.
The confusion arises because some payers use both: DSM for clinical documentation for preauthorization and utilization review, and ICD for billing.
Patrick signed into law "An Act to Increase Opportunities for Long-Term Substance Abuse Recovery,'' which is intended to promote access to addiction treatment by removing preauthorization requirements and mandating insurance coverage of inpatient treatment.
Front office staff must be diligent about preauthorization, copayments and deductibles, especially for high-value procedures.
Removes the portion of the bill's definition of preauthorization.
He said that with pregnancy terminations determined to be medically necessary, the surgeon performing the procedure would have to request preauthorization with documentation of second opinions from two independently practicing physicians who can speak to the risk posed to the mother's health or life based on the continuation of the pregnancy.
Accurate verification of patient's insurance eligibility and constant checks done of preauthorization number, deductibles, plan exclusions, claim mailing address, policy status- ensuring minimum rejections