Prior Authorization
A payer’s advance approval that a service is covered — required for many procedures before they are performed.
Get a Free Billing AuditDefinition
A prior authorization (also called pre-authorization or pre-certification) is a payer’s advance approval that a specific service, procedure, medication, or item will be covered. For many services the plan requires this approval before care is delivered.
Which services need authorization, and what documentation supports it, varies by payer and plan — so the requirement has to be checked for the specific patient’s coverage, not assumed from a general list.
Why it matters for billing
A missing or expired prior authorization is one of the most common — and most preventable — reasons a claim is denied, and these denials are frequently hard to overturn after the fact. Verifying and tracking authorizations up front protects the claim before the service ever happens.
Related terms
Terms that come up alongside Prior Authorization in the revenue cycle.
Billing that gets Prior Authorization right
EnVisionMD RCM handles eligibility, coding, documentation, denials and follow-up end to end — so the details behind terms like this one are managed for you, not left to chance.
Request a free billing reviewPrior Authorization — frequently asked questions
No. It confirms the service is authorized as medically appropriate, but final payment still depends on eligibility, coding, and the plan’s terms at the time the claim is processed.
It depends on the payer and plan. The requirement must be verified for the individual patient’s coverage rather than assumed.