Members pre-certify to ensure the service meets the clinical requirements for medical necessity, appropriateness, level of care or effectiveness per the applicable health benefit plan.

Pre-certification is the prospective review of diagnostic tests, durable medical equipment, medical treatment and medical procedures which determine medical necessity and/or the continuation or choice of further medical services.

These services are filtered through the process of prior authorization, utilization review and/or case management to ensure consistency with clinically supported symptoms, diagnosis or indications of the injured person(s) and that the level of medical service is in accordance with the standards of good practices and standard professional treatment protocols.