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What is pre-certification in medical billing?

Question:

What is pre-certification in medical billing?

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Answer:

Pre-certification notices are sent by a care provider to notify the patient's healthcare provider that an elective, non-urgent service is need. The pre-certification notice is sent so that the healthcare provider can review the needed procedure and determine whether or not it would be covered by the patient's healthcare plan. Pre-certification is, essentially, the opposite of pre-authorization, which requires healthcare plan review in the case of a necessary and/or urgent medical service. Pre-certification requests coverage, and is used to get permission from healthcare providers to proceed with the service. In the pre-certification process, determining whether or not a procedure or service should be provided is left to the discretion of the health care provider or insurer. This means that it is not guaranteed that the service/procedure will actually be covered by the patient's healthcare plan.

For more information on medical insurance billing, check out this article: Medical Insurance Biller: Summary of Career Education

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