Professional StaffingHuman Resource ConsultantsOpen Late

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Hours

Mon 7:00 AM to 9:00 PM
Tue 7:00 AM to 9:00 PM
Wed 7:00 AM to 9:00 PM
Thu 7:30 AM to 9:00 PM
Fri 7:00 AM to 9:00 PM
Sat Closed
Sun Closed

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About Portiva

Prior Authorization Prior authorization: This is confirmation in advance of your health plan that you are about to receive a service or fill a prescription. This approval is necessary because your plan may not cover the to or prescription. What exactly is Prior Authorization, and why does it matter to healthcare? Also referred to as preauthorization and precertification, prior authorization is when health plans make the patient obtain their approval before receiving any healthcare. Only after receiving approval from the health insurance company can a doctor or hospital provide service. The principle behind measures like requiring prior authorization of use is that there may be a less expensive but equally effective method. This is especially true for high-cost procedures and drugs, like outpatient surgery, MRI’s durable medical equipment (DME), and specialty drugs. This is critical because it lets the plan determine whether or not care is medically necessary and covered. This process of reviewing standards is often done by the plans themselves, based on medical principles, cost considerations, and utilization trends. Prior authorization is the most common drug utilization management method in the U.S. healthcare system infrastructure. Therefore, the main objective of prior authorizations is to ensure that drug therapy will be medically necessary, clinically appropriate, and based on official evidence-based guidelines. Prior authorizations not only can reign in the cost of prescription drugs, but they also have a patient safety function-reducing imprudent use and improvement across such areas as drug interactions and adverse events caused by drugs’ off-label usage for patients with diagnoses that are insufficiently supported. Thus, if a treatment or prescription is particularly complicated, you’ll often have to get permission beforehand. You won’t be covered with it. That’s why it is important to obtain prior authorization as early as possible. A simple-seeming term, prior authorization is becoming an increasingly lethal obstacle in healthcare. It often arises as a barrier between you and the services or medications you need, leaving you scrambling for answers and wondering: What is prior authorization, and how does one go about it?

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