Executives

Precertification Intake Support involves determination of precertification requirement of an upcoming medical/surgical procedure. It consists of frontline professional staff who take incoming calls either from members or providers

Front line staff accepts incoming calls from members or providers to determine precertification requirement for any medical and surgical procedure

• Screens requests in order to appropriately refer items to the medical services staff
• Utilizes reference tools to determine the need for notification and medical review
• Collates medical information and determines precertification review in accordance with the benefit plan
• Assigns length of stay based on approved reference tools for certain elective inpatient surgical procedures
• Pend cases that require medical review
• Appropriately identifies cases for case management and disease management
• Performs Non-medical research including eligibility verification, coordination of benefits and benefits verification

• OUTPUT

  : Medical procedures/ services authorized or cases created and sent to clinicians for review.