Prior Authorisation
A mandatory payer approval process, completed before a rehabilitation technology device is dispensed, confirming medical necessity and coverage eligibility.
Full Definition
Prior authorization (PA) is the formal review and approval process required by many insurance payers—including Medicare Advantage plans and private insurers—before complex rehabilitation technology or other high-cost medical equipment is supplied to a patient. The process requires submission of clinical documentation including physician orders, assessments, and justification letters. Editors working on PA submissions must ensure completeness of documentation, accurate coding references, and consistent patient identifiers. In US English, the preferred spelling is 'prior authorization' (z), while 'prior authorization' (s) is standard in UK and Australian English—confirm house style. The term is often abbreviated PA in clinical communications.
Usage
Usage note: US style: 'prior authorization' (z). UK/Australian style: 'prior authorization' (s). Do not confuse with 'predetermination,' which is a cost estimate rather than an approval to proceed.
In Context
- "The prior authorization request was denied because the supporting documentation did not include a signed physician order." — Insurance appeals correspondence
- "Standardize the spelling as 'prior authorization' throughout; the document currently alternates between the s- and z-spellings." — Copy-editing note