Prior Authorization
Insurance company approval required before providing certain physical therapy services to ensure coverage and prevent claim denials.
Full Definition
Prior authorization is a utilization management process where insurance companies review and approve physical therapy services before they are provided. This process typically requires submission of clinical documentation demonstrating medical necessity, functional limitations, and treatment plans. Authorization may specify the number of visits, types of services covered, and duration of coverage. Failure to obtain required prior authorization can result in claim denials and financial liability. The authorization process varies by insurance company and may require periodic re-authorization based on patient progress and continued need for services.
Usage
Usage note: Always verify authorization requirements before beginning treatment to avoid claim denials.
In Context
- "Prior authorization obtained for 12 physical therapy visits over 6 weeks." — Insurance documentation
- "Treatment cannot begin until prior authorization is received from the insurance company." — Administrative procedure