Prior authorization is a process where your healthcare provider must get approval from your insurance company before performing a specific medical service, test, or prescription. It's used to confirm the service is medically necessary and covered by your plan.
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Pre-authorization, also known as prior approval or pre-certification, is a process that requires healthcare providers to obtain permission from a health plan prior to offering certain medical services or prescribing specific drugs. For a detailed, easy-to-understand guide prior authorization for medical services , check out the Pharmbills Blog. They break down the entire process, highlighting key stages, common issues, and practical strategies to improve approval rates—perfect for streamlining your operations.