Pre-authorisation
A process by which a dental practice submits proposed treatment details to an insurer for review and estimated benefit determination before treatment is rendered.
Full Definition
Pre-authorisation (also called predetermination or prior authorisation) is an administrative procedure in which a dentist submits a treatment plan — including CDT codes, tooth numbers, and supporting radiographs — to a patient's dental insurer before performing the planned treatment. The insurer reviews the submission and returns an estimate of the benefits payable, though this is not a guarantee of payment. Editors working on dental benefit communications or patient financial discussion forms must distinguish pre-authorisation from a guarantee of coverage, and must flag any language that conflates the two. Spelling varies between 'pre-authorisation' (British/Australian) and 'pre-authorization' (US); house style should be applied consistently throughout a document.
Usage
Usage note: Apply house style consistently: 'pre-authorisation' (Commonwealth) vs. 'pre-authorization' (US). Never describe a pre-authorisation as a guarantee or approval of coverage.
In Context
- "The practice submitted a pre-authorisation request for the proposed crown and implant before scheduling the surgical appointment." — Insurance correspondence
- "Patient financial forms must state clearly that a pre-authorisation is an estimate, not a guarantee of payment." — Patient financial agreement template