Question

Prior Authorizations

Prior authorizations

You are interning at Dr. Smith’s family practice office. The practice manager for Dr. Smith tells you that tomorrow you will be working with Jane who does prior authorizations for this busy office.

You are unfamiliar with the term prior authorization so you plan on researching this topic tonight. Prepare a document that illustrates what you find in researching prior authorizations. Include what prior authorizations are, what services typically require prior authorizations, why they are important and why a prior authorization might not be approved.

Answer 1

The prior authorizations are something whch a person or the institution obtaining prior permission inorder to perform its functions smoothly and to provide the services with continuity. Some times the request for the pre authorization can get rejected due to the limited access of the insurance companies or due to the criterias like age and comorbidities which they have implimented during the process of joining the paricular insurance policy.

The services require the prior authorizations are CT/MRI,administering costly medications like high end antibiotics,chemotherapy drugs etc.Also need to have the prior authorization for certain invasive procedures and refferals.

As mentioned above the prior authorizations are necessary to provide care with continuity.Also the unnecessary decisions on one client by a single person can be eliminated.The real need and the necessities will be taken care and the unwanted things which can mess up the patient care can be avoided.Some times the pre authorisations can get rejected due to the high cost claims.