Alabama Procedure For Pre-Certification

State:
Alabama
Control #:
AL-033-WC
Format:
PDF
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Description

Procedure For Pre-Certification

Alabama Procedure For Recertification is a process that is used to make sure that medical services meet the necessary criteria for reimbursement. It is a way for health care providers to get prior approval for certain medical services. There are three types of Alabama Procedure For Recertification: 1. Recertification for Inpatient Services: This is required for all inpatient services, including medical, surgical, and inpatient mental health services. It involves submitting a request for recertification through the Recertification system, which is reviewed by a Medical Reviewer. If approved, the provider will be issued a Recertification number. 2. Recertification for Outpatient Services: This is required for all outpatient services, including medical, surgical, and outpatient mental health services. The provider must submit a request for recertification through the Recertification system, which is reviewed by a Medical Reviewer. If approved, the provider will be issued a Recertification number. 3. Recertification for High-Risk Services: This is required for specific high-risk services, such as certain procedures and surgeries that require additional review prior to approval. The provider must submit a request for recertification through the Recertification system, which is reviewed by a Medical Reviewer. If approved, the provider will be issued a Recertification number. Once the Recertification number has been issued, the provider can then submit claims for reimbursement.

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Precertification for medical services is the process of obtaining approval from an insurance company for the healthcare consumer to have a medical service. Use prior authorization tips and guides to improve administrative efficiencies.Many health plans require pre-certification and sometimes predetermination of medical necessity prior to care being rendered. The Myndshft Ultimate Guide to Prior Authorization helps demystify PA and to quickly answer some of the most frequent questions. Sometimes called prior authorization, prior approval or precertification. Get information about Aetna's precertification requirements, including precertification lists and criteria for patient insurance preauthorization. Sometimes called prior authorization, prior approval or precertification. A health plan may require that you meet specific criteria before a medical procedure or prescription drug is covered. Without this prior approval, your health insurance plan may not pay for your treatment, leaving you responsible for the full bill. This entails a payer needing to review whether the proposed service is medically necessary, or not.

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Alabama Procedure For Pre-Certification