Quick Answer: What Is A Medical Authorization?

What is an authorization in healthcare?

A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary.

Sometimes called prior authorization, prior approval or precertification.

Preauthorization isn’t a promise your health insurance or plan will cover the cost.

What is a medical authorization form?

A HIPAA authorization form is a document in that allows an appointed person or party to share specific health information with another person or group. Your appointed person can be a doctor, a hospital, or a health care provider, as well as certain other entities such as an attorney.

How long are medical authorizations good for?

HIPAA does not impose any specific time limit on authorizations. For example, an authorization could state that it is good for 30 days, 90 days or even for 2 years. An authorization could also provide that it expires when the client reaches a certain age. In this case, the 90-day expiration date is set by the agency.

What is the difference between a referral and an authorization?

A referral is issued by the primary care physician, who sends the patient to another healthcare provider for treatment or tests. A prior authorization is issued by the payer, giving the provider the go-ahead to perform the necessary service.