What is preadmission certification, prenotification or precertification, and what do they have to do with my coverage?
Preadmission certification, prenotification and precertification are terms relating to medical cost-containment programs. They involve review of medical necessity and whether alternate treatment methods are more appropriate. You may have a penalty deducted from your medical benefits if you are required to prenotify or precertify and fail to do so. Your claim also could be denied if the service is not medically necessary. For more information, see Utilization Management. Consult your benefit booklet or call Customer Service at the number on your ID card to determine if you are subject to prenotification or precertification prior to receiving certain medical services.
Related Questions
- When will the updated certification program for CSB preadmission screeners be available? Will currently certified CSB prescreening evaluators be required to complete the program?
- What is preadmission notification (sometimes referred to as precertification or prenotification) and when is it needed?
- Does pre-admission certification guarantee coverage?
