predetermination


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predetermination

Managed care A requirement for prior approval from a health insurer before it will pay for a proposed treatment. See Red tape rationing.

pre·de·ter·mi·na·tion

(prē'dĕ-tĕr'mi-nā'shŭn)
Determination of the reimbursement amount from a third-party payor before a health care service is performed. It does not guarantee coverage.

pre·de·ter·mi·na·tion

(prē'dĕ-tĕr'mi-nā'shŭn)
Determination of the reimbursement amount from a third-party payor before a health care service is performed. It still does not guarantee coverage.

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.
References in periodicals archive ?
Predetermination of power positions is often extended throughout the various representative and administrative institutions of the state.
Methods for predetermination and determination of costs:
This objection overlooks an important distinction, namely that between predetermination and what might be called precedence determination.
Unlike certiorari review, the direct appeal process does not require the court to make a predetermination before the opposing party presents its case and the parties have a much longer period of time to research the law, formulate their arguments, and file the necessary briefs.
Well-crafted agreement terms will address provider obligations, define payment values, consider rules governing Medicare coverage and provide a good framework for predetermination and pre-authorization requirements.
At the same time, it carries the teleological danger of ineluctability, of predetermination.
In addition, plans may have a feature called a predetermination of benefits.
And while that is certainly true, the key to "Up in Michigan" is the predetermination of this separation as derived from Milton.
The problem for materialists, according to Beauregard, is that the subjective experience of free will necessitates an agent that can sometimes completely override that alleged biological predetermination, or "the roulette wheel's spin.
Calibration-free are measurement methods, which allow to determine a certain quantity within certain accuracy limits without necessity of predetermination of any unknown parameters.
No specific predetermination needs to be made about what household activities to consider as 'work' and no wage proxies need to be chosen.
IT WAS the health and safety police who wrecked your traditional Mathew Street festival, fearing that, having no self control or predetermination, you may trip over a stray Big Dig paving stone or topple over a street barrier.