predetermination

predetermination,

n an administrative procedure whereby a dental professional submits a treatment plan to the carrier before treatment is initi-ated. Then the carrier returns the treat-ment plan, indicating the patient's eligibility, covered service amounts payable, application of appropriate deductibles, copayment factors, and maximums. Under some programs, predetermination by the carrier is required when covered charges are expected to exceed a certain amount, commonly $100. Also known as
preauthorization, precertification, preestimate of cost, and
pretreatment estimate.