Pre-certification is a process similar to prior authorization, whereby a request for approval for a service is performed without the need to verify medical necessity; typically entails verifying that a service is a covered benefit with a contracted, in-network provider and at an in-network facility.
How to Prepare Your Prior Authorization Workflows for CMS-0057-F and Beyond
Our practical checklist and workflow mapping guide helps patient access leaders assess and organize their prior authorization processes before CMS-0057-F’s FHIR-based API requirements take effect in 2027.
