Question

What is the difference between a pre-authorization and a referral? 

Answer 1

ANS)

PRE- AUTHORIZATION

This is a procedure in which the doctors or any other health contributor is needed to acquire advance acceptance from the scheme for a act of assistance and this is also called as pre-service authorization appeal.

The pre-authorization is provided by the payer,permitting the physician to proceed to carry out the required assistance.

REFERRAL

This is a procedure in which the member's primary care doctor or any other general practitioner allows or orders the member to acquire an act of assistance from other doctor or another health care contributor type.

The referral is given by primary care doctor,who direct the client or patient to another doctor for the examination and therapies.

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