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How does prior authorization work?

Prior authorization means that a health provider needs to get approval from a patients health plan before moving ahead with a treatment, procedure, or medication.

What is a prior authorization and how does it work?

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.

Is it difficult to get prior authorization?

Often, insurance companies have strict deadlines for PAs. Often, insurance companies have specific expectations for when the information needs to be submitted, and knowing those key dates is important. An expedited approval process is likely available if your need is urgent or time-sensitive.

How long does pre authorization take?

Pre-authorization can take a few minutes to several days, depending on the complexity of the procedure or service being requested. For example, some medical procedures may require extensive paperwork and review by an insurance provider before they are approved.

How do you deal with prior authorization in medical billing?

If prior authorization is needed, potential CPT codes that will be billed along with the ICD10 codes of the patients diagnosis must be submitted to the insurance company. The insurance company will then decide whether to allow authorization for the procedure to be billed.

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