Title: Competency Assessment: (CU2 M3) Obtain Precertification
Course: SkillsCom CRS 110 14.0 > Section: Credit Unit 2 Module 3

Instructions:

Precertification is defined as "a formal assessment of medical necessity, efficiency, or appropriateness of a medical provider's treatment plan for a specific illness or injury."  It is customary to contact the patient's insurance company to obtain approval for a procedure and/or service.

The following case study is for patient John Q. Smith.  He was injured while competing in a rodeo as a bull rider. You as a coding and reimbursement specialist need to get precertification from his insurance company for his required surgery.

Assignment:

1. Review the following documents:

- Patient information sheet for John Q Smith (PDF Download)
- Physician chart notes for John Q Smith (Google Doc)

2. Based on the information provided in the documentation, complete the precertification documentation linked below, which is necessary to submit to the insurance company:

Precertification Form for HMO Louisiana, Inc. (PDF Download)