Instructions:
Precertification is defined as "a formal assessment of medical necessity, efficiency, or appropriateness of a medical provider's treatment plan for a specific illness or injury." It is customary to contact the patient's insurance company to obtain approval for a procedure and/or service.
The following case study is for patient John Q. Smith. He was injured while competing in a rodeo as a bull rider. You as a coding and reimbursement specialist need to get precertification from his insurance company for his required surgery.
Assignment:
1. Review the following documents:
2. Based on the information provided in the documentation, complete the precertification documentation linked below, which is necessary to submit to the insurance company:
Precertification Form for HMO Louisiana, Inc. (PDF Download)