Common use of Pre-Certification Clause in Contracts

Pre-Certification. The Pre-Certification program consists of a review of proposed treatment involving inpatient or day admissions for surgical, medical, obstetric, pediatric, psychiatric and substance abuse cases, outside of a physician's office and as described in the Physician Group Handbook. Pre-Certification is required in advance as described in the Physician Group Handbook for all elective hospital admissions, surgical or invasive procedures, and high cost non-invasive services such as MRI, CT and other diagnostic services (excluding Emergencies). All elective admissions require Pre-Certification. For urgent or Emergency admissions, notification of Company is required as described in the Physician Group Handbook or as soon as is practicable.