Prior Authorization

Prior authorization, or pre-auth, is done before a clinical intervention is delivered. The purpose of the pre-auth is to put a control in place designed to ensure that the requested clinical service or procedure is appropriate and that it will be delivered in an appropriate setting. Typically, a set of criteria helps to determine the appropriateness of the request and when available national standards of care are used. In addition to cost control, the prior authorization process can facilitate communication within the healthcare organization about patients who are being evaluated for or who are diagnosed with specific conditions, which may improve access to different services, and which may encourage more effective coordination of care for the patient by the organization. Source: Giardino AP, Wadhwa R. Utilization Management. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: [https://www.ncbi.nlm.nih.gov/books/NBK560806/](https://www.ncbi.nlm.nih.gov/books/NBK560806/)