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.
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Today, AIM Inform includes prior authorization programs for outpatient high-tech, diagnostic imaging services, and there are plans to expand to other AIM-managed clinical areas such as oncology, musculoskeletal, and genetic testing in future releases.
Even assuming that there was no prior authorization from the Sanggunian, accused Echiverri's act of awarding the subject contract to RSCS was not unjustified or done without adequate reason,' the decision read.
In one specific case, 81% of the reimbursed cost for a patient visit was consumed by seeking a prior authorization.
In 2015, I wrote a column, "Prior authorization for medications: Who oversees placement of the hoops?" The article followed my unsuccessful 6-week-long endeavor to get modafinil authorized for a patient.
In February, the association released results of a survey of more than 1,000 practicing physicians, finding that an overwhelming 91 percent say that prior authorization programs--which patients may need to access before obtaining certain drugs, tests and treatments--have negative impacts on clinical outcomes.
Faster turnaround times:62 percent of prior authorization (PA) requests submitted electronically receive a determination in less than two hours, compared to 0 percent of PA requests completed via the traditional phone and fax method.2
Requiring prior authorization, Greenwald asserted, can delay addiction treatment, potentially missing the opportunity to intervene with patients struggling with addiction.
Historically, the prior authorization (PA) process has been manual via paper, faxes, and phone calls between providers, pharmacies, and insurers.
Manual prior authorization (PA) often results in treatment delays and gaps in therapy.
teammate" for prior authorizations. Lia helps CFOs and VPs of Revenue Cycle improve the patient experience, increase team productivity, secure revenue, and reduce clinician burnout by automating, accelerating, and reprioritizing prior authorization tasks.
- Columbus, Ohio-based electronic prior authorization solution provider PriorAuthNow has closed a USD 10.5m series A funding round led by Atlanta, Georgia-based venture firm BIP Capital, the company said.
Physicians, pharmacists, hospitals, medical groups, and health insurance companies announced they'll work together to come up with solutions to prior authorization headaches.