Prior authorization is a payer’s requirement that certain services, procedures, or medications be approved before they’re performed, not after. Skipping this step doesn’t just risk a delay — for many payers, it results in an automatic denial with no option to appeal after the fact, regardless of medical necessity.
The services that typically require prior auth vary by payer and plan, but commonly include advanced imaging (MRI, CT scans), certain surgical procedures, specialty medications, and some outpatient procedures. The specifics change often enough that relying on memory or last year’s rules is a common source of denials — checking current requirements per payer, per service, is the only reliable approach.
The practices that avoid prior authorization denials build it into their scheduling workflow rather than treating it as a billing-department task after the fact. When prior auth status is checked at the time a procedure is scheduled — not the day before, and not after the visit — there’s enough lead time to actually secure approval before the date arrives, rather than discovering the requirement only when the claim bounces back.