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predetermination |
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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. predetermination Managed care A requirement for prior approval from a health insurer before it will pay for a proposed treatment. See Red tape rationing. How to thank TFD for its existence? Tell a friend about us, add a link to this page, add the site to iGoogle, or visit webmaster's page for free fun content. |
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