A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification.
What is the purpose of a prior authorization?
Prior authorization—sometimes called precertification or prior approval—is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.
Who submits prior authorization?
The healthcare provider is usually responsible for initiating prior authorization by submitting a request form to a patient's insurance provider.
Is Preauthorize one word or two?
pre·auth·or·i·za·tion In the U.S., authorization of medical necessity by a primary care physician before a health care service is performed.
Is pre authorization hyphenated?
No hyphen. Do not use the terms “preauthorization” or “precertification” interchangeably in the same communication.
What does it mean if prior authorization is approved?
Prior authorization is the formal approval issued by a health insurance provider that's needed before certain procedures may be performed or medications are prescribed. Without this approval, the insurer won't cover the cost of the procedure.Jun 1, 2021
How long does it take for a prior authorization to be approved?
Depending on the complexity of the prior authorization request, the level of manual work involved, and the requirements stipulated by the payer, a prior authorization can take anywhere from one day to a month to process.
What does it mean to need a prior authorization?
A prior authorization (PA), sometimes referred to as a “pre-authorization,” is a requirement from your health insurance company that your doctor obtain approval from your plan before it will cover the costs of a specific medicine, medical device or procedure.
What information is needed for prior authorization?
- • Patient name, date of birth, insurance policy number, and other relevant information.
- • Physician and facility information (eg, name, provider ID number, and tax ID number)
- • Relevant procedure and HCPCS codes for products/services to be provided/performed.