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Prior authorization is a check run by some insurance companies or third-party payers in the United States before they will agree to cover certain prescribed medications or medical procedures. [2] There are a number of reasons that insurance providers require prior authorization, including age, medical necessity, the availability of a generic ...
(Reuters) - Health insurer Cigna Group said on Thursday it would remove the use of prior authorization or paperwork required to get approval for insurance coverage for 25% of medical services.
Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its medical appropriateness before it is provided, by using evidence-based criteria or guidelines.
The bill defines prior authorization as “the process by which utilization review entities determine the medical necessity and medical appropriateness of otherwise covered health care services ...
It is a type of prior authorization requirement that is intended to control the costs and risks posed by prescription drugs. The practice begins medication for a medical condition with the most cost-effective drug therapy and progresses to other more costly or risky therapies only if necessary.
Some medical software requires a prescription. [44] Legislation may define certain equipment as "prescription devices". [45] Such prescription devices can only be used under the supervision of authorized personnel and such authorization is typically documented using a prescription.