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What is medication authorization?

In medical billing, authorization describes the process where a healthcare provider like you gets approval from an insurance company before performing certain medical services or procedures.

What is the medical authorization process?

This is a process where your medical provider must get approval from your health plan before you can have a certain medical service or treatment. Prior authorizations are very common: there are over 35 million prior authorization requests submitted each year on behalf of Medicare Advantage patients alone.

How do prior authorizations work for medication?

A denied prior auth request can occur when a providers office submits a wrong billing code, misspells a name or makes another clerical error. Requests can also be denied if the prior auth request lacks sufficient information about why the medication or treatment is needed.

What is a medical authorization?

While receiving medical care or picking up a prescription, you may have heard about something called prior authorization. Prior authorization requires your doctor or provider to obtain approval from your health plan before providing health care services or prescribing prescription drugs.

How do medical authorizations work?

Certain medications and medical services need to be approved by Blue Shield of California before they will be covered. This is called a prior authorization. This helps make sure the drug or service is safe and necessary for your care. Your doctor or provider usually makes this request for you.