Which document is commonly required by some payers to authorize a procedure in advance?

• A. Preauthorization form
• B. Referral
• C. Payment plan
• D. Post-procedure note

Answer: (A)

Prior authorization is the process many payers use to approve a procedure before it’s done, ensuring the service is medically necessary and covered. A preauthorization form is the document that captures the patient’s information, the proposed procedure (with codes), and the clinical justification so the insurer can decide whether to authorize payment in advance. If the payer approves, coverage is clarified ahead of time; if not, the service may be denied or the patient may face higher costs.

A referral is a separate step that tells the payer a patient needs to see a certain provider or specialist, but it doesn’t authorize the actual procedure itself. A payment plan is simply a financial arrangement for paying the bill after services are provided. A post-procedure note is documentation created after the procedure, not a pre-service authorization.