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Who is responsible for obtaining preauthorization?

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.

Why is it so hard to get a prior authorization?

An electronic prior authorization (ePA) is a simple and secure way to complete prior authorization requests online. Only your doctor can submit the form. We suggest they use Surescripts. Ask your doctor to send your form electronically to speed up the process.

Why are prior authorizations so difficult?

Shifting rules and overall payer complexity make it difficult for health systems to stay ahead of what they need to get prior authorization requests approved, which lengthens the time an auth takes and results in more denials.

Why do prior authorizations get denied?

The most common reason in my experience why PA requests get denied, is quite simply a lack of information. For example, its very common for PA requests for MRIs or CTs to require that an X-ray and/or ultrasound be done first, to see if that will provide enough information for the doctor to treat the issue.