occurs when procedures and/or services are used only when an insurer is asking for a work related or medical disability exam

Precertification

Explanation:

For managed care organizations to pay for medical services, precertification needs to be done. Precertification involves proving to the medical insurance company that a service is medically necessary. After precertification, the insurance company would determine if the service is a covered service before payment is made.

Precertification is taken by the insurer to provide the insurance company with procedures and/or services and diagnosis.