Radiology

Exam Precertification and Its Importance

What is precertification?

Precertification, sometimes referred to as preauthorization, is the process used by health insurance companies to confirm that a service to be performed is medically necessary. Many health insurance plans require precertification for outpatient advanced imaging prior to the scheduled appointment.

What types of imaging procedures may require precertification?

The following may require precertification:

How does the precertification process work?

Within the Radiology Department here at Cincinnati Children’s, we have a precertification team that works closely with health insurance companies and referring physicians to ensure the precertification process is followed and completed in a timely manner. Once a radiology appointment is scheduled, our team begins the process by contacting your insurance company and submitting all of the necessary information. Often, automatic approval is obtained. At times a medical necessity review is required, meaning a physician employed by the health insurance company will review your examination details and may require peer-to-peer discussion with your referring physician. Failure to secure precertification prior to an appointment could result in a denial for the imaging examination and your claim may not be paid by your health insurance company. If an imaging procedure is denied, the precertification team will work diligently with you, your referring physician, and your insurance company to determine the appropriate next steps.

Our Commitment

The Cincinnati Children’s Radiology Department is committed to working together with our patients and their families to assist in the examination precertification process. We are dedicated to the ultimate goal  of making it easy and affordable to obtain world-class healthcare for your child.

Contributed by Lisa Ulland and edited by Tim O’Connor, Dir. Imaging Informatics.

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