Prior Authorization
Prior authorization is payer review of whether a service, medication, or procedure is approved before it is provided or paid.
Healthcare compliance context
This definition is for healthcare technology research only and is not payer, billing, legal, or clinical advice. Prior authorization requirements vary by payer, plan, service, and policy.
FAQs
- How can AI support prior authorization?
- AI can help collect documentation, summarize requirements, draft requests, check status, and route exceptions, but payer-specific review is still needed.
Related Terms
Revenue Cycle Management
Revenue cycle management covers the administrative and financial workflow from patient access to payment.
Healthcare Automation
Healthcare automation uses software to reduce manual work across clinical, administrative, and operational workflows.
Claims Scrubbing
Claims scrubbing checks claims for errors, missing data, or rule issues before submission.
Related Items
Cohere Health
Clinical intelligence platform for prior authorization, utilization management, and payment integrity workflows.
Waystar
Healthcare revenue cycle platform with AI-powered workflows across financial clearance, claims, denials, analytics, and patient payments.
Availity
Healthcare intelligence network supporting eligibility, authorizations, claims, payments, APIs, and AI-enabled payer-provider workflows.