Precertification definition
Precertification means certain covered outpatient prescription drugs will require an approval where the prescribed medication will be reviewed by Us to determine Medical Necessity before the prescription is filled. This approval process is called the prior authorization process.
Precertification means a function performed by EGID, or its designee to review and certify medical necessity prior to the receipt of service for hospital admissions and all outpatient surgical procedures.
Precertification means a function performed by EGID, or its designee to review and certify medical necessity prior to the receipt of service for hospital admissions.
Examples of Precertification in a sentence
Seller shall obtain CEC Precertification by the Commercial Operation Date.
Air Ambulance service for non-Emergency Hospital to Hospital transports require Precertification.
If You need inpatient Hospital care, Your Provider should contact Us for Precertification.
Fixed and Rotary Wing Air Ambulance services that are not provided through the 911 emergency response system require Precertification.
However, by following the Pre-certification process both you and the Dentist will know in advance which services are covered and the benefits that are payable.
More Definitions of Precertification
Precertification means approval by the Company that the service or supply is Medically Necessary and/or not experimental or investigational.
Precertification means any written or oral determination made at any time by an
Precertification means the process detailed in Section 2.3.1 of this Certificate whereby all non-emergency inpatient hospital admissions or certain designated procedures and services as listed in Section 2.3 of this Certificate are reviewed by the PPO for coverage determination based on Medical Necessity prior to the provision of services.
Precertification means authorization from this Plan for specific Covered Expenses in accordance with the Care Management Programs section. Requesting Precertification is a Pre- Service Claim as described in the Claims Procedures; Payment of Claims section.
Precertification means a process under which certain drugs require prior authorization (prior approval) before Plan Participants can obtain them as a covered benefit. The Aetna Pharmacy Management Precertification Unit must receive prior notification from physicians or their authorized agents requesting coverage for medications on the Precertification List.
Precertification means those pro- grams established by us where the “medical necessity” of certain medical procedures, treatments, “diagnostic tests”, or other services, non-medical expenses and durable medical equipment are subject to prior authorization by us or our designated representative, and are also subject to utilization review and/or case management by us.
Precertification or "precertification request" means the procedures in an insurer's approved decision point review plan for the insurer to receive notice and respond to requests for listed specific medical procedures, treatments, diagnostic tests, other services and durable medical equipment that are not subject to decision point review and that may be subject to overutilization.