A prior authorization determination refers to the decision made by a health insurance company regarding whether to approve or deny a request for coverage of a specific medical service, procedure, or medication. This determination is based on factors such as medical necessity, coverage policies, and clinical guidelines.
How to Prepare Your Prior Authorization Workflows for CMS-0057-F and Beyond
Our practical checklist and workflow mapping guide helps patient access leaders assess and organize their prior authorization processes before CMS-0057-F’s FHIR-based API requirements take effect in 2027.
