Billing & ClaimsPregunta 52 de 100
Prior authorization (precertification) is:
a.Payment made before a service
b.A patient's written consent to treatment
c.The final step after a claim is paid
d.Approval obtained from the payer before a service to confirm it will be covered
Explicación
Prior authorization is the payer's advance approval that a planned service or item is medically necessary and covered, often required for imaging, surgeries, and certain drugs. Failing to obtain required authorization commonly leads to denial. It is separate from, and does not guarantee, final payment.
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