GLOSSARY - INSURANCE
What is Insurance Prior Authorization?
Last reviewed:
Quick Answer
Insurance Prior Authorization is the process insurers use to determine whether they will cover a specific service, procedure, or medication before it's provided. AI automates policy review, medical necessity assessment, and approval decisions—reducing processing time and improving consistency.
Definition
**Insurance Prior Authorization** ensures proposed services align with policy terms and medical necessity standards. AI systems evaluate clinical documentation, apply policy rules, check regulatory requirements, and generate approval/denial decisions with complete audit trails.
Key Points
- Evaluates services against policy coverage terms
- Assesses medical necessity and appropriateness
- Applies regulatory and state-specific requirements
- Reduces authorization processing time significantly
- Improves consistency in approval decisions
- Maintains audit trails for regulatory compliance