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prior authorization

What Is Prior Authorization in Healthcare?

Prior authorization is a health insurance requirement that asks a healthcare provider to obtain approval from a health plan before certain medical services, prescription drugs, procedures, or medical equipment are provided. It is also called preauthorization, prior approval, or precertification. The purpose is generally to determine whether a requested service meets the insurer’s coverage or […]

Medical Eligibility Verification

What Is Medical Eligibility Verification?

Medical Eligibility Verification is the process of checking a patient’s health insurance coverage before healthcare services are provided. It helps a medical practice confirm whether a patient is currently covered, what benefits may apply, and what portion of the healthcare cost may be the patient’s responsibility. For medical practices, eligibility verification is an important part […]