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 ?
With its new rule requiring preauthorization of compound prescription drugs, Texas has become the latest state to attempt to curb the unnecessary use of compound drugs in workers' compensation.
The New York Times reports that few opioids require preauthorization and readily are covered by insurance plans.
Studies of managed care systems have demonstrated that preauthorization of studies or clinical decision support systems can decrease the use of advanced imaging modalities.
Many insurance companies require a preauthorization.
Providers in Illinois, Michigan and New Jersey must get regulators' preauthorization of expenses before treating Medicare patients for the most commonly approved conditions in non-emergency cases.
The recent PCSK9-inhibitor experience highlighted the frequent preauthorization roadblocks and denied coverage that providers and patients must navigate.
Curiously, TennCare requires an often denied preauthorization for the drug Chantix to help patients stop smoking and reduce the medical costs resulting from the cigarettes they buy at the governor's gas stations.
That price difference is largely because private health insurers often require preauthorization before doctors are allowed to treat patients--authorization doctors have to spend time convincing insurers to allow, according to Dr.
Preauthorization is required for certain specific antibiotics, and the use of prophylactic antibiotics.
Related: Feds hint at coming mental parity suits EBSA Answers Mental Parity Preauthorization Questions
These nodes can stream data to and from other collection nodes and smart/disparate sensors to several cognitive-analysis terminals at specific levels of command (theater, corps, division, and brigade) and locations (continental United States, rear areas, forward-deployed areas) based on preauthorization authority.