Glossary
Prior authorization
Prior authorization is payer approval before a service, extra visit, or exception is billed. Some states use a different term, such as prior approval.
Quick path
Start with the step you need.
- 1Find the rule for your stateStart with the state where the client has Medicaid coverage.Choose your state
- 2Check what is missingReview setup, visit notes, codes, and payer steps before billing.Use the checklist
- 3Save the checklistDownload the checklist, then keep client details in your own secure records.Open checklist
Why it matters
If approval is required and missing, the claim may deny even when the service is otherwise covered.