What process involves determining eligibility and benefits before providing services to a patient?

The process of determining eligibility and benefits before providing services to a patient is known as pre-authorization. This step is critical in healthcare billing as it ensures that the patient is covered for the services they are about to receive and that those services fall within the guidelines of their insurance plan. Pre-authorization typically involves the healthcare provider submitting a request to the insurance company to confirm that the proposed treatment is necessary and eligible for coverage. This helps to prevent unexpected costs for the patient and ensures that the healthcare provider will be compensated for the services rendered.

Pre-authorization is essential for maintaining compliance with insurance requirements and streamlining the billing process. It helps to manage costs and avoid denials based on coverage issues. In contrast, post-claim review, clearinghouse management, and claim adjustment relate to the claims process after services have been provided rather than before. Thus, recognizing pre-authorization as the correct answer highlights the importance of proactive measures within the healthcare billing framework.