The prior authorization (prior auth, or PA) process itself can be complicated and requires both communication and a cohesive healthcare team. The healthcare team involved in the PA process consists of a provider or physician, the pharmacy, the payer, and the patient. Each player on this team plays a part in successful and positive patient outcomes.
Tag Archives: prior authorization
Summary: Help Process Insurance Claims and Payments
Handling insurance claims and processing insurance are important functions within the pharmacy. There are roles dedicated to dealing with insurance claims, payer policy, and prior authorization. Dr. Amanda DeMarzo, PharmD, MBA, PACS is the Associate Director, Patient Access with the National Board of Prior Authorization Specialists. She encourages enhancing patient access through education and certification. […]
Pharmacy’s Role in the Prior Authorization Process
Prior authorization processes continue to grow year after year. With an ever-growing need to decrease costs, many health plans are increasing the number of prior authorizations required for both medical and prescription benefits. Prior authorizations are utilization processes used by insurance companies to determine coverage for healthcare. What are the steps of prior authorization? There […]
