Prior authorization guides for practices
Plain-language guides to prior authorization: what it is, what goes in a packet, and how to appeal a denial.
- What is prior authorization?Prior authorization is a payer's approval, requested before a service, that it meets medical-necessity criteria. Who does what, and why it takes time.
- What goes in a prior authorization packetA checklist of what a prior authorization request usually contains: identifiers, codes, clinical justification, supporting documents and the request letter.
- Appealing a prior authorization denialWhat to do when a payer denies a prior authorization request: read the reason, check the deadline, add what was missing and appeal in writing.