Precertification
Precertification is a payer's advance review confirming that a planned service meets its coverage criteria before the service is provided — for most payers, another name for prior authorization.
Updated
Precertification (also written precert or pre-certification) is a payer's requirement that certain services be reviewed and approved in advance, against the plan's coverage and medical-necessity criteria, before they are delivered. For most payers the term is used interchangeably with prior authorization and preauthorization.
The words are not standardized across the industry. A given plan may draw a fine distinction between precertification, preauthorization, and predetermination, or may use them as synonyms, so the meaning that governs a specific claim is the one in that payer's own policy rather than a universal definition.
In practice
Because the labels vary, the safest practice is to work from each payer's published requirement rather than from the word it uses. What matters operationally is the same regardless of the name: whether advance approval is required for the service, what documentation supports it, and what reference number the approval produces for the claim.
Commonly confused with
- Prior authorization: For most payers these are the same requirement under different names; where a plan distinguishes them, its own policy is the controlling definition.
- Predetermination: A predetermination is typically a non-binding estimate of coverage; precertification is generally a required approval to obtain before the service.