Prior Authorization Request or Submission is when the provider or supplier submits a pre-claim review request and receives the decision prior to claim submission. However, the provider or supplier can render services before submitting the request. A provider or supplier submits the prior authorization or pre-claim review request with all supporting medical documentation to approve coverage for the item or service to their payer.
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.
