Examine medical documentation (e.g., treatment plans, referrals, prescriptions) to determine if PA is needed.
Verify with insurance payers whether prior authorization is required for the requested service, medication, or procedure.
Accurately complete and submit PA forms via payer portals like Availity, eCareNext, or through EPIC workflows.
Contact insurance companies by phone, fax, or online portal to initiate and follow up on authorization status.
Monitor pending authorizations and follow up with payers regularly until a determination is received.