Prior authorization—sometimes called pre–authorization or pre–certification—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. Prior authorization is a formal request made by the medical provider (before offering a medical service) seeking authorization from the insurance company to proceed with a medical service. Authorizations can be sought for tests, surgeries, prescriptions, and other medical services.
What are the KPIs You Should Know for Prior Auth Management and Performance Evaluation?
Learn the most critical metrics to improve your prior auth processes.
