Get Prior Authorization Request Form

The healthcare provider is usually responsible for initiating prior authorization by submitting a request form to a patient's insurance provider.

How Long Does Prior Authorization Take? Prior authorization can take days to process. Within a week, you can call your pharmacy to see if the prior authorization request was approved. If it wasn't, you can call your insurance company to see why the authorization was delayed or denied..

How does the prior authorization process work? Prior authorizations for prescription drugs are handled by your doctor's office and your health insurance company. Your insurance company will contact you with the results to let you know if your drug coverage has been approved or denied, or if they need more information.

For example, services that may require pre-certification include outpatient and inpatient hospital services, observation services, invasive procedures, CT, MRI and PET scans, and colonoscopies. Patients are responsible for knowing the pre-certification requirements of their health plans.

How do I get a prior authorization? Your doctor will start the prior authorization process. Usually, they will communicate with your health insurance company. Your health insurance company will review your doctor's recommendation and then either approve or deny the authorization request.

Prior authorization works by having your health care provider or supplier submit a prior authorization form to their Medicare Administrator Contractor (MAC). They must then wait to receive a decision before they can perform the Medicare services in question or prescribe the prescription drug being considered.

Typically within 5-10 business days of hearing from your doctor, your health insurance company will either approve or deny the prior authorization request. If it's rejected, you or your doctor can ask for a review of the decision.

Now, when a prescription comes into their PMS electronically, the system determines whether a PA is required and then transmits that PA request immediately to the physician. The pharmacy can do it all online without paper or faxes or phone calls.

A prior authorization (PA), sometimes referred to as a pre-authorization, is a requirement from your health insurance company that your doctor obtain approval from your plan before it will cover the costs of a specific medicine, medical device or procedure.