Individual qualified to practice in a specialized professional field (e.g., family practitioner or nurse practitioner).

Component of a managed care plan that reviews an inpatient hospital stay prospectively to determine coverage. Also called preauthorization. See precertification.

Review by a quality improvement organization (QIO) for specific surgical procedures and scheduled inpatient services that must be approved before being provided. Also called preprocedure review.

Treatment, tests, and procedures done 48 to 72 hours before admission of a patient into the hospital. This is done to eliminate extra hospital days.

Requirement in some health insurance plans for a physician or provider to obtain permission for a service or procedure before it is done and to see whether the insurance program agrees it is medically necessary. Factors determining authorization are eligibility, benefits of a specific plan, and setting of care. Also called approval, authorization, or preapproval. See also precertification and predetermination.