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Author Question: What is credentialing?[br][br][b][color=black]Question 2[/color][/b][br][br]What is the difference ... (Read 109 times)

Capo

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on: Jul 12, 2018
What is credentialing?

Question 2

What is the difference between prior authorization and concurrent review?


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joewallace

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Reply #1 on: Jul 12, 2018
Answer to Question 1

Credentialing means reviewing a provider who has applied to participate in a health plan.

Answer to Question 2

Preauthorization (prior authorization): the review of elective procedures that require prior approval before being reimbursed.
Concurrent review: reviewing services ordered for medical necessity during an inpatient hospitalization before they are provided.


Capo

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Reply 2 on: Jul 12, 2018
Great answer, keep it coming :)

debra928

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Reply 3 on: Yesterday
Thanks for the timely response, appreciate it

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