Definitions for "Prior Authorization"
See prior approval.
To be sure certain drugs are used correctly and only when truly necessary, plans may require a “prior authorization.” This means you will need a prior approval from your plan before a particular drug will be covered. In many instances, your doctor or health care provider must first contact the plan and show there is a medically-necessary reason why you must use that particular drug for it to be covered.
Also called Pre-certification or Pre-authorization Prior review of a proposed service using established criteria to determine the appropriateness of care.
The acceptance of financial liability for services to be rendered by a provider to an individual by the payer. This does not automatically ensure payment.
Keywords:  predetermination, see
see Predetermination.