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)