Definition
Preauthorization vs. Predetermination refers to two different payer processes used before care is delivered. Preauthorization (prior authorization) is mandatory approval confirming medical necessity for specific services; failure to secure it often results in a 100% denial even if the patient is eligible (e.g., MRI or sleep study). Predetermination, common in dental, is a voluntary review that estimates coverage and patient cost (e.g., a predetermination for a crown returns an allowed amount of $1,200 with 50% coinsurance), but it is not a guarantee of payment.
Why it matters
Missing prior authorization can drive 10–20% of preventable write-offs and reschedules, disrupting multi-location schedules and cash flow. For DSOs, timely predeterminations increase case acceptance and production; moving approval turnaround from 5–7 days to 24–48 hours can add hundreds of booked procedures per month. In a $200M service line, cutting auth-related denials by just 1 percentage point protects $2M annually.
How Ventus helps
Ventus handles both: dental pre-authorization and predetermination, and medical procedure authorization, in one workflow. Each request is assembled to the payer's requirements and followed until the payer returns a determination, which is written back into the practice management system. Drug and biologic prior authorization is not supported.
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