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Prior authorization is costly, inefficient and responsible for patient care delays. The AMA stands up to insurance companies to eliminate care delays, patient harm and practice hassles.
Prior authorizationsometimes called preauthorization or precertificationis a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.
Insurance companies can deny a request for prior approval for reasons such as: The doctor or pharmacist didnt complete the steps necessary. Filling in the wrong paperwork or missing information such as service code or date of birth. The physicians office neglected to contact the insurance company due to a lack of
Prior authorization specialists usually: Discuss medications, insurance and prior authorization documents with patients. Get prior authorization approval from insurance firms and nurse managers. Appeal insurance companies after prior authorization refusals. Assess accounts for completeness and accuracy.
Why does my health insurance company need a prior authorization? The prior authorization process gives your health insurance company a chance to review how necessary a medical treatment or medication may be in treating your condition. For example, some brand-name medications are very costly.
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