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Tag: CMS Guideline

Prior authorization (or preauthorization) is a process where a health plan, like an insurance company, must approve a prescribed procedure, medication, or service before it's provided to the patient. This step ensures the care is medically necessary, safe, and cost-effective, and the health plan may not cover the cost without this prior approval. Common examples include expensive or complex medical procedures, specialty medications, and some durable medical equipment.

Prior Authorization in Medical Billing

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