Retro authorization is a process where the payer reviews a service that has already been performed to determine if it was covered under the patient’s insurance policy and is medically necessary. This is typically done after the service has been completed and is used to recover payment for services that were not previously authorized.Â
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.
