Medical Predetermination Definition

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Health Insurance Terms: What is a predetermination?

https://connect.bcbstx.com/understanding-benefits/b/weblog/posts/health-insurance-terms-what-is-a-predetermination

A predetermination of benefits is a review by your insurer’s medical staff. They decide if they agree that the treatment is right for your health needs. Predeterminations are done before you get care, so you …

Predetermination | definition of predetermination by …

https://medical-dictionary.thefreedictionary.com/predetermination

(111) The court, defining "predetermination" as occurring only when an agency "irreversibly and irretrievably commits itself to a plan of action that is dependent upon the …

Understanding Predetermination - BCBSIL

https://www.bcbsil.com/PDF/sprint_understanding_predetermination.pdf

“Predetermination” is a review by Blue Cross and Blue Shield of Illinois (BCBSIL) of a doctor’s recommended medical procedure, treatment or test to make sure it meets …

Difference Between Predetermination and Prior Authorization

https://www.outsourcestrategies.com/blog/predetermination-vs-prior-authorization/

A predetermination is a formal review of a patient’s requested medical care compared to their insurance’s medical and reimbursement policies (MGMA). …

Recommended Clinical Review (Predetermination) | Blue Cross …

https://www.bcbsil.com/provider/claims/claims-eligibility/utilization-management/predetermination

A recommended clinical review (formerly called predetermination) is a medical necessity review conducted before services are provided. Submitting the request prior to rendering …

Insurance approvals: pre-certification and prior …

https://www.mayoclinic.org/patient-visitor-guide/billing-insurance/insurance/insurance-approvals

Insurance approvals: pre-certification and prior authorizations. Your Mayo Clinic doctor will decide which procedures, tests and other consultations you may need. However, many …

Referral, predetermination, authorization, precertification: What's …

https://www.mgma.com/resources/operations-management/guide-to-closing-a-private-equity-transaction-pre

A predetermation is a formal review of a patient’s requested medical care compared to their insurances’ medical and reimbursement polices. The provider’s …

Predetermination Definition & Meaning - Merriam-Webster

https://www.merriam-webster.com/dictionary/predetermination

predetermination noun pre· de· ter· mi· na· tion ˌprē-di-ˌtər-mə-ˈnā-shən Synonyms of predetermination 1 : the act of predetermining : the state of being predetermined: such as …

What Is a Pre-Determination Letter for Health Insurance?

https://budgeting.thenest.com/predetermination-letter-health-insurance-32746.html

A pre-determination letter is a letter or form sent from a medical provider, such as a doctor or surgeon, to a patient's health insurance carrier to determine if the planned services will …

Predetermine | definition of predetermine by Medical …

https://medical-dictionary.thefreedictionary.com/predetermine

pre·de·ter·mi·na·tion ( prē'dĕ-tĕr'mi-nā'shŭn) Determination of the reimbursement amount from a third-party payor before a health care service is performed. It does not guarantee …

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