What is preauthorization and what services typically require it?

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Multiple Choice

What is preauthorization and what services typically require it?

Preauthorization means you obtain approval from the payer before performing a service to confirm it will be covered and medically necessary. This step helps ensure the service will be paid and meets the payer’s criteria. It’s commonly required for high-cost or invasive procedures and for many imaging studies, hospital admissions, certain surgeries, anesthesia, durable medical equipment, and some therapies beyond standard limits. If preauthorization isn’t obtained, the claim may be denied or paid at a reduced rate. Note that eligibility verification, a claim form, and a deductible are separate concepts; preauthorization specifically refers to the pre-approval of the service itself.

Preauthorization means you obtain approval from the payer before performing a service to confirm it will be covered and medically necessary. This step helps ensure the service will be paid and meets the payer’s criteria. It’s commonly required for high-cost or invasive procedures and for many imaging studies, hospital admissions, certain surgeries, anesthesia, durable medical equipment, and some therapies beyond standard limits. If preauthorization isn’t obtained, the claim may be denied or paid at a reduced rate. Note that eligibility verification, a claim form, and a deductible are separate concepts; preauthorization specifically refers to the pre-approval of the service itself.

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