prior authorization


Also found in: Acronyms.

prior authorization

Health insurance A cost containment measure that provides full payment of health benefits only if the hospitalization or medical treatment has been approved in advance

prior authorization

The approval by an insurer or other third-party payor of a health care service before the service is rendered. This approval is required in order for the insurer to pay the provider for the service.

prior authorization,

References in periodicals archive ?
The groups say they want to streamline the prior authorization request process by pushing for adoption of national electronic document exchange standards, and by trying, whenever possible, to use existing standards, such as the standards pharmacies already use.
962 million drainage project also without prior authorization of the Sanggunian Panlungsod.
TELECOMWORLDWIRE-January 18, 2017-Recondo Technology to automate prior authorizations for hospitals
This new rule could prompt DMEPOS suppliers to request additional documentation from ordering/prescribing physicians to support the suppliers' requests for prior authorization.
Medicare managers themselves have estimated that about 20 percent of claim denials are for prior authorization requests, the reps say.
In doing so, Merge and eviCore expect to bring a new level of operational efficiency to imaging centers and referring physicians, with the potential to help lower the risk of providers going unreimbursed for medical payment claims based on incomplete or absent prior authorization documentation.
Zito and her colleagues collected information about prior authorization requirements for atypical antipsychotic prescribing for all 50 states and the District of Columbia.
In the past 18 to 24 months, requirements for prior authorization for medications have steadily increased.
CompletEPA utilizes recently established industry standards for ePA from the National Council for Prescription Drug Programs and leverages Surescripts' eligibility and formulary data to proactively notify providers of prior authorization requirements within the e-prescribing work flow.
If you provide clinical care, you've probably dealt with third-party payers who require prior authorization (PA) before they will pay for certain treatments.
Humana's prior authorization rate rose from 5% of claims in 2011 to 14% in 2012.
The costly administrative burdens of the prior authorization process can complicate medical decisions and delay or interrupt patient care," said Dr.