Florida Health Insurance Definitions

Florida Health Insurance Terms:

Define: "Pre-Authorization"

Preauthorization (sometimes also referred to as pre-certification) is an important process with private insurers in making sure the physician and the hospital or surgery center receive appropriate payment for services delivered. Insurers vary with respect to their preauthorization policies and the type of information they require.

OTHER USES -- "Pre-authorization is a prospective determination performed by licensed health-care professionals and trained pre-authorization analysts working under the direction of licensed registered nurses. The intent is to determine medical necessity and to assess the appropriateness of the proposed treatment, level of care, length of stay and appropriate treatment setting. Pre-authorization is also used to identify members for case management or disease management programs."

More Examples of Pre-Authorization:

Pre-authorization pertains to medical necessity only, and does not guarantee payment. It is not a treatment recommendation or a guarantee that your patient will be insured or eligible for benefits when services are performed. The pre-authorization

Further details - Pre-Authorization:: Search Regence Health


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