Billing & ClaimsCâu 52 / 100
Prior authorization (precertification) is:
a.Payment made before a service
b.A patient's written consent to treatment
c.The final step after a claim is paid
d.Approval obtained from the payer before a service to confirm it will be covered
Giải thích
Prior authorization is the payer's advance approval that a planned service or item is medically necessary and covered, often required for imaging, surgeries, and certain drugs. Failing to obtain required authorization commonly leads to denial. It is separate from, and does not guarantee, final payment.
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Câu hỏi liên quan cùng chủ đề
- Timely filing limits refer to:
- On the CMS-1500 form, the National Provider Identifier (NPI) is used to:
- The electronic equivalent of the paper CMS-1500 professional claim is the:
- Verifying a patient's insurance eligibility before the visit helps to:
- The 'place of service' code on a professional claim indicates:
- Which item is generally required for a clean professional claim?
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