Medical Expense✓ Verified · outline & fact-checked · Sep 2026Difficulty 1/5
The managed care process that requires a physician to obtain the plan's approval before admitting a patient to the hospital is called:
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Precertification, also known as pre-admission certification or prior authorization, is a utilization review step in which the insurer or managed care organization approves a proposed hospital admission, procedure, or treatment before it occurs. If the member does not obtain precertification, benefits may be reduced or denied. Utilization review tools are used by managed care plans to control costs and ensure that care is medically necessary, appropriate, and provided in the most cost-effective setting.
Why the other options are wrong
- A) Case management coordinates care for complex, high-cost cases and does not by itself mean pre-admission approval.
- B) Concurrent review evaluates the patient's care during the hospital stay, not before admission.
- D) Discharge planning arranges care after discharge, such as home health, and is not the approval before admission.
Memory hook
Pre = before the hospital door. Precertification is the plan's 'may we proceed?' stamp for admissions.