| 释义 |
preauthorization preauthorization (prē'aw-thōr-i-zā'shŭn), A prerequisite, often intended as a rate-limiting or cost-containment step, in the provision of care and treatment to an insured patient. A practitioner who expects to be paid for a service must use paperwork and telephone contact with a designated entity (often clerks, but sometime medical professionals), often a TPA, to determine whether the proposed treatment or procedure is deemed medically necessary for the health and welfare of the covered party.
See also: benefit, health maintenance organization, managed care, fee-for-service insurance, traditional indemnity insurance. preauthorization Managed care The requirement by an HMO that a costly surgery, specialist referral or non emergency health care services be approved by the insurer before it is allowed. See HMO. pre·auth·or·i·za·tion (prē'awth'ŏr-ī-zā'shun) In the U.S., authorization of medical necessity by a primary care physician before a health care service is performed. A referring health care provider must be able to document why the procedure is needed. It does not guarantee coverage.
See also: assignmentpre·auth·or·i·za·tion (prē'awth'ŏr-ī-zā'shun) In the U.S., authorization of medical necessity by a primary care physician before a health care service is performed. A referring health care provider must be able to document why the procedure is needed. It still does not guarantee coverage. |