What is a Prior Authorization and Why is it Important

What is precertification, prior authorization, or pre-approval? Today, many procedures and diagnostic tests, regardless of provider specialty, require prior authorization, but what exactly is it, and why do you need it? A prior authorization request provides information to the insurance carrier, who then will provide written confirmation that the procedure or diagnostic test can be performed based on medical necessity. Having a pre authorization approval ensures insurance coverage and payment of explicit medical services before they are performed on the patient.

However, obtaining prior authorizations might not always be easy. Most insurance companies have different requirements and restrictions based on their individual guidelines. To make matters more complicated, these authorization guidelines are frequently updated and vary based on individual plan coverage as well. 

As a result, our team of authorization and eligibility verification experts manually checks every individual CPT code submitted for precertification by the provider and ensures that all services provided are payable.

If your practice is looking for help with prior authorizations and eligibility verification, we’re happy to help. Contact us!

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