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Basically, prior authorization is the process of getting permission from a patients health insurance company before a service is provided. The healthcare providers staff normally obtains prior authorization for such services as office visits, procedures, tests, prescription medications, MRI, CT, and PET scans. Insurance companies use prior authorization to make sure that services meet medical necessity, and as a means to control costs and utilization. In some cases, services provided without prior authorization result in denial of health insurance claims, causing non-payment to healthcare providers, or increased out-of-pocket expenses for patients.

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13y ago

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