Medical Authorization Codes
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FAQ
It is a legal process performed to ensure that insurance providers pay for the particular medical services that are billed in a medical claim. Insurance verification and authorization play a significant role in revenue cycle management.
The number assigned by the medical reviewer and reported by the provider to identify the medical review (treatment authorization) action taken after review of the beneficiary's case. It designates that treatment covered by the bill has been authorized by the payer.
As for the authorization of the medical procedure, the responsibility goes to the health care provider. The provider must apply for authorization before performing the procedure. Once approved, the payer then provides the health care provider with an authorization number for any further references.
An authorization code is an alphanumeric password that authorizes its user to purchase, sell or transfer items, or to enter information into a security-protected space.
After determining the patient's insurance eligibility, the insurance verification team should validate whether prior authorization is needed. If prior authorization is needed, potential CPT codes that will be billed along with the ICD10 codes of the patient's diagnosis must be submitted to the insurance company.
