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Is there a difference between pre-certification and prior authorization?

April 26, 2017Authorization difference pre-certification prior

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Is there a difference between pre-certification and prior authorization?

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Yes. Pre-certification refers to obtaining authorization for the hospital stay (number of days) and typically refers to hospital reimbursement only. Prior authorization is the verification of benefits and determination of coverage for the procedure to be performed. This refers to both physician and hospital reimbursement.