predetermination


Also found in: Dictionary, Thesaurus, Legal, Financial, Encyclopedia, Wikipedia.

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 ?
enforcement of conciliation from predetermination agreements in cases
349, 394 (1974) (asserting amendment calls for judicial predetermination of probable cause inherent in warrant requirement).
From predetermination, the claim moves to rating teams who review all medical evidence; specialists sort through all treatment records from military and civilian parties.
He said: "The Conservative group are moving an amendment, but we will listen to all the arguments for and against - we do not want to be accused of predetermination.
Industrial safety and radiological safety are also enhanced by laser scanning data, and using 3-D PLM allows for predetermination of hazards in workspaces," he said.
But I have no predetermination," the French minister said.
What are the links between predetermination and an ancestral/legendary unconscious?
Commission Chairman Steven Ungar told the audience at a National Guard armory auditorium that the agency has no predetermination about how or whether to change compensation rates.
Predetermination of sex in livestock offspring is of critical importance for the efficient production of the world's food supply (Johnson et al.
Dr Alfredo Le Pera, in November 2003 published a research entitled "Trabajos Tecnicos Nacionales" "Ciclo Presupuestario Integrado Predetermination de Costos en el Sector Publico"
To that end, his reassessment of the concept of free will includes numerous distinctions: between productive (or metaphysical) and moral (or motivational) freedom, free decision and free actions, motivational and causal determination of choices, predetermination and precedence determination, and other relevant issues.