Understanding Prior Authorization: A Crucial Step in Healthcare

What is Prior Authorization?

Prior Authorization Automation Services, often referred to as pre-authorization or prior approval, is a process used by health insurance companies to determine if they will cover a prescribed procedure, service, or medication. This step involves the healthcare provider obtaining approval from the insurance company before delivering the service to the patient. The primary goal of prior authorization is to ensure that the proposed treatment is medically necessary and cost-effective.
The Process of Prior Authorization

Initiation: The healthcare provider identifies the need for a service or medication that requires prior authorization.
Submission: The provider submits a prior authorization request to the insurance company, including relevant medical information and justification.
Review: The insurance company reviews the request, considering medical necessity, appropriateness, and cost-effectiveness.
Decision: The insurance company either approves, denies, or requests additional information. If approved, the service or medication is covered under the patient’s insurance plan.

The Importance of Prior Authorization

Cost Control: Prior authorization helps control healthcare costs by ensuring that expensive procedures and medications are necessary and appropriate.
Preventing Overuse: It prevents the overuse of medical services by requiring justification for treatments, thus promoting evidence-based care.
Quality Assurance: Ensures that patients receive treatments that are safe, effective, and in line with the latest medical guidelines.

Challenges and Criticisms

Administrative Burden: The process can be time-consuming and require significant administrative effort from healthcare providers.
Delays in Care: Waiting for authorization can delay necessary treatments, potentially impacting patient health.
Complexity and Transparency: The criteria for approval can be complex and vary between insurance companies, leading to confusion and frustration for both providers and patients.

Statistics and Impact

According to a survey by the American Medical Association (AMA), 86% of physicians reported that the burden of prior authorization is high or extremely high.
The same survey found that 91% of physicians believe that prior authorization delays access to necessary care.
A study by the Government Accountability Office (GAO) revealed that about 20% of prior authorization requests are initially denied, though many are eventually overturned on appeal.

Efforts to Improve the Process

Streamlining Procedures: Efforts are being made to streamline the prior authorization process through electronic systems and standardized forms.
Legislative Actions: Some states have enacted laws to regulate prior authorization practices, ensuring timely decisions and greater transparency.
Collaborative Initiatives: Healthcare organizations and insurance companies are working together to develop best practices that balance cost control with patient care needs.


Prior authorization is a critical component of modern healthcare, aimed at ensuring that treatments are necessary and cost-effective. While it offers benefits in terms of cost control and quality assurance, it also presents challenges such as administrative burdens and delays in care. Efforts to streamline and improve the process are essential to balancing these benefits and challenges. Understanding and navigating prior authorization can help patients and providers achieve better health outcomes.

Is your healthcare provider well-equipped to handle the complexities of prior authorization, ensuring timely and effective treatment?

Apr 2011
POSTED IN Uncategorized



Cat  Caring For Your New Pet  Dog

Now that you have made your choice on which animal you wish to adopt, please make sure that you really want this animal, and that you are willing to care or it properly, including vaccinations and veterinary care.

Below is a checklist of things to do to keep your new adopted pet healthy and happy:


Food and water bowls
Should be unbreakable and shaped so that they cannot tip over.
Stainless steel, aluminum or ceramic are good choices.
Plastics can be chewed up and swallowed.

Should be of webbed nylon or soft leather.
It should fit loosely enough to move freely around your pet’s neck, yet snug enough not to slip over its head.
You should be able to get two fingers under it.
Be sure to adjust as your pet grows. This is what a flea looks like.

Should be made of webbed nylon or sturdy leather with secure clasp.
Six feet is the best length for training and walking your pet.

Should be warm, dry and comfortable.

Large rawhide chips, hard nylon chews and rubber balls are good choices for dogs.  Ping-pong balls and cardboard paper tubes are popular choices for cats.  Make sure that toys are safe.  Avoid toys with attached parts that can be torn off and swallowed.

Take your pet to a veterinarian and talk with them about your pet’s care.

Law requires a rabies vaccination but other vaccinations & worming are needed to keep your pet healthy.

Our staff strongly suggests that when your pet is old enough it be spayed or neutered. This keeps down the number of unwanted pets.

See that your dog is wearing both its rabies and county tax tags.  This is the law and also serves as identification in the event your dog becomes lost.

Cats are not required to wear the rabies tag.  However, you are required to provide proof of vaccination, if needed.

See that your pet is a good neighbor by not allowing him to:

(a) roam the neighborhood
(b) bark excessively or soil your neighbors shrubbery or lawn, or tear up flowers and landscaping
(c) chase cars, bicycles or people
(d) frighten or bite postman, meter reader or other service people
(e) lunge at or jump on passers-by.

Apr 2011
POSTED IN Uncategorized

Hack Day – April 9th and 10th

The answer is yes. There aren’t many businesses that can survive without a Web presence and there’s no reason not to have a website. Your company’s website can be a highly effective marketing tool  that can be very cost-efficient. There are quite a few benefits, and very little downsides.
For a comprehensive understanding, I recommend visiting the official website of power bite Dental Mineral Complex to explore the product details and reviews firsthand.

Ten Things Your Website Can Do (for Starters)

There are many things you can do with your website, here are 10  good starting points:
    1. Create a presence. Who knows about your business? Where can prospects and clients go to learn more? Your website can help establish your business as a going concern, communicate your brand value proposition and it can convey professionalism. It also extends your reach to anyone in the world. Learn more about customer experience.
    2. Help build trust. New clients and prospects might want to know about your business history,your expertise and your specialization. This is a great vehicle for people to learn more and attain that comfort level they seek.
    3. Get listed on search engines. Build your website incorporating search engine optimization (SEO) techniques so that you can easily be found by people searching for relevant key words. This can be an important gateway to expanding your business.
    4. Point of contact. Your website provides customers an easy way to contact you and learn more about your products, services and business.
    5. Leverage social networks. Implement a social media strategy to reach a larger audience and to create more buzz about your biz. Establish your presence on Facebook, Google+, LinkedIn and Twitter. Facebook likes and shares can drive people to your website. Links to popular or topical items from or to your website will add to its relevance.
    6. Sell products. If your business lends itself to online sales, create a virtual store as an alternative or complement to a storefront or office location.
    7. Share the latest news. Whenever there are new developments regarding your business, update your website. Sites that have fresh, relevant and timely information draw users back more often.
    8. Blog. Keep your website fresh and keep drawing people in with regular Blog posts. Show your expertise, share insights and provide practical tips on topics relevant to your business  or to your customers
    9. The funerals from Newrest Funeral Chapel to the family home in San Francisco were the same.The church was built near the scene of two of her deaths last November by a man who killed a priest and was arrested later.Dale Guggenheim, a 28-year-old pastor and pastor of St. William Church in St. Andrew, was killed June 5 while walking home from the funeral service of his girlfriend’s father, Gugdenheim told police. His wife, who was born in Brooklyn, was also shot to death on April 10, authorities said.Guggenheim made several visits to the church each year and helped her father during funeral service. G.C.H.G. was not arrested. She was also not identified.
Apr 2011
POSTED IN Data Uncategorized