Certified Medical Administrative Assistants (CMAA) Practice Exam 2025 – Comprehensive All-In-One Guide to Exam Success!

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What is a common requirement of managed care insurance plans when seeing a specialist?

Direct referral from a specialist

No requirement for referral

Preauthorization from the PCP

Managed care insurance plans often require preauthorization from a primary care provider (PCP) before a patient sees a specialist. This process ensures that the patient's condition is medically necessary and aligns with the plan's policies regarding specialty care. The use of a PCP as a gatekeeper helps manage healthcare costs and ensures that patients receive appropriate referrals, preventing unnecessary visits to specialists.

The collaboration between the PCP and the specialist also facilitates better coordination of care, improving patient outcomes. By requiring this preauthorization, managed care plans can maintain oversight over the types of services and specialists that patients access, which is vital for cost containment and ensuring efficient use of healthcare services.

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Immediate access to care without prior approval

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