Okuzeka
Healthcare Management vocabulary · Health Insurance and Reimbursement

Prior authorization

Meaning in healthcare management, with examples

nounCommon term

In healthcare management, prior authorization means: Approval that a provider must get from an insurer before certain tests, treatments or medicines; without it, the insurer may refuse to pay.

In Turkish: provizyon, ön onay, ön izin

How it is used

Also called pre-authorization, preauthorization or 'prior auth'. Staff request, obtain or submit prior authorization, and the insurer approves or denies it. Delays in prior authorization are a common source of frustration for doctors and patients alike.

Example sentences

  1. The MRI was postponed because prior authorization had not come through.

  2. We have a dedicated team that handles prior authorization for cancer treatments.

Common collocations

  • request prior authorization
  • obtain prior authorization
  • prior authorization form
  • prior authorization denied
  • coverageThe range of treatments and costs that an insurance policy or public health system pays for, and the people who are protected by it.
  • claimA formal request that a hospital or patient sends to an insurer or public payer, listing the care given and asking to be paid for it.
  • claim denialA payer's refusal to pay a claim, for example because approval was missing, the codes were wrong, documents were missing or the service is not covered.
  • payerAn organisation that pays for patients' healthcare, such as a government health fund, a social security institution or an insurance company.

More terms: Health Insurance and Reimbursement

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This page explains English vocabulary for learners. It is not medical advice.