Glossary

Plan Administration

Supervision of the details and routine activities of installing and running a health plan. This includes answering questions, enrolling individuals, billing and collecting premiums, and other duties.

Pre-Admission Certification

Also called pre-certification review, or pre-admission review, this is the approval given 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 admittance, pre-admission certification must often be obtained by the individual. Sometimes, however, physicians will contact the appropriate approver. The goal of pre-admission certification is to ensure that individuals are not exposed to inappropriate health care services (services that are medically unnecessary).

Pre-Admission Review

A review of an individual's health care status or condition, prior to an individual's admission to an inpatient facility, such as a hospital. Pre-admission reviews are often conducted by case managers or insurance company representatives (usually nurses) in cooperation with the individual, his or her physician or health care provider, and a hospital.

Pre-existing Conditions

A medical condition that is excluded from coverage by an insurance company because the condition was believed to exist prior to the individual obtaining a policy from the particular insurance company.

Preadmission Testing

Medical tests that are completed for an individual prior to being admitted to a hospital or inpatient health care facility.

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