Pre determination

General Query
#1

HI Everyone,

What is the difference b/w Pre-Authorization, Predetermination and Coverage Eligibility?

We do not have Predetermination In our current services. So, trying to understand the purpose and difference b/w preauthorization, predetermination & coverage Eligibility.

There is no structure definition specific to Predetermination. The fields are same for Preauthorization & predetermination.

On high level, the query is:

  1. When exactly the predetermination service is used?
  2. In order to build sample data, what structure definition to be referred?

Thanks
Santosh
FHPL