Question

Providing the diagnosis when requesting precertification for a procedure will help the insurance

carrier to determine what?
A. Patient viability
B. Medical necessity
C. Diagnosis code
D. Procedure code

Answer 1

Precertification helps the insurance carrier determine the B. medical necessity of a procedure based on the diagnosis provided.

Step-by-step explanation:

When requesting precertification for a procedure, providing the diagnosis helps the insurance carrier to determine medical necessity. By knowing the diagnosis, the carrier can assess whether the procedure is required and justified based on the patient's condition.

The diagnosis code, known as the ICD code, is used by the insurance carrier to evaluate the appropriateness of the procedure and ensure it aligns with accepted medical guidelines and practices. Precertification is important because it ensures that the insurance company approves the procedure before it is performed, reducing the chances of denial of payment.