Prior authorization is a process used by some health insurance companies in the United States to determine if they will cover a prescribed procedure, service, or medication. It is a decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification.
The term "precertification" is the process of when the hospital obtains eligibility, certification or authorization and collecting information from the health plan prior to inpatient admissions and selected ambulatory procedures and services. It is also known as pre-admission certification, pre-admission review, and 'pre-cert'.