What is the purpose of precertification?

• A. Verification of coverage
• B. Prior authorization for treatments
• C. Scheduling for benefits
• D. Post-service billing

Answer: (A)

Precertification is the pre-service check to confirm that the patient has active coverage for the planned procedure and that the service is eligible for reimbursement under their plan. It often includes confirming medical necessity and obtaining any required prior authorization. By verifying coverage before the service, it helps prevent denials and unexpected patient costs and guides the provider on payer requirements. This step isn’t about scheduling for benefits or post-service billing, which happen at different stages.