Definitions for "Pre-Admission Certification"
Review and approval process completed before hospital admission to ensure the medical necessity for the acute level of care and for the proposed services and procedures, to avoid a weekend admission, and to forecast the expected length of stay. The review process may include an assessment of the physician's proposed treatment protocol and fees. Compliance with changes in the treatment plan recommended by the reviewing entity may be a condition of receiving full coverage under the health benefit. The benefit level may be reduced or services not covered at all if the patient fails to comply with plan requirements. The pre-admission review process may also include an administrative confirmation of the patient's eligibility for benefits, covered services and restrictions, and the determination of applicable deductibles, co-payments, and maximums.
The practice of reviewing claims for hospital admission before the patient actually enters the hospital. This cost-control mechanism is intended to eliminate unnecessary hospital expenses by denying medically unnecessary admissions.
Review and approval for necessity and appropriateness of the care proposed for a patient prior to the patient's admission to a hospital or other health care facility.  Under health plans where PAC is required, pre-admission certification is a prerequisite for payment.