Prior authorization is a step in the healthcare process where medical providers seek approval from a patient's insurance provider before proceeding with certain treatments, procedures, or medications. This process helps verify that the service is medically necessary and eligible for coverage under the patient’s plan. It plays a key role in managing healthcare costs and promoting appropriate use of medical resources.

Prior authorization ensures providers are reimbursed for services by confirming coverage before treatment. This reduces claim denials, minimizes costly appeals, and streamlines revenue cycles—allowing providers to focus more on patient care than administrative follow-ups.

Efficient prior authorization can significantly improve patient satisfaction by preventing delays or cancellations of care due to insurance issues. It also provides patients with greater clarity about coverage and potential out-of-pocket costs before receiving treatment.

Services that often require prior authorization include advanced imaging (like MRIs), elective surgeries, specialist referrals, durable medical equipment, and high-cost medications. Requirements vary by insurance plan, so verification is key.