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.
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.
