pre-admission certification

What is pre-admission certification?

Pre-admission certification – also called pre-certification review, or pre-admission review – refers to approval by a case manager or insurance company representative (usually a nurse) for a person to be admitted to a hospital or in-patient facility, granted prior to the admittance.

Pre-admission certification often must be obtained by the individual. Sometimes, however, physicians will contact the appropriate individual. The goal of pre-admission certification is to ensure that individuals are not exposed to inappropriate health care services (services that are medically unnecessary).

Learn about how balance billing affects insured patients.