What is the difference between pre-certification and pre-authorization and provide a list of services that may require pre-authorization?
Please note that these definitions are commonly used interchangeably. Pre-authorization: The process of obtaining prior approval for health care coverage based on a plan’s requirements for coverage. Pre-authorization does not guarantee coverage. Pre-certification: A review of a proposed hospital or healthcare facility admission or of certain services or procedures prior to receiving them, in order to determine whether the proposed admission or services meets the medical necessity criteria for payment and to receive the maximum benefits available under a healthcare plan. This is a typical list of services found in a majority of plans that may require pre-certification.
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