Prior authorization—sometimes called precertification or prior approval—is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.
The AMA believes that the overall volume of medical services and drugs requiring prior authorization should be greatly reduced.
When it is used, prior authorization should utilize a standardized, automated process to minimize the burden placed upon both physicians and health plans.
As reform and research continue, the AMA offers the following resources to help minimize the current impact of prior authorization on practices.
Electronic prior authorization videos
Learn how electronic prior authorization (ePA) technology that integrates with practices’ current electronic prescribing workflows can improve the drug prior authorization process by watching the AMA’s 3-part ePA video series. Physicians can register to receive 0.25 credits of AMA PRA Category 1 Credit™ for viewing these informational videos.
Prior authorization toolkit
The prior authorization toolkit provides an overview of the current prior authorization landscape, including the status of ePA adoption.
Prior authorization tip guide
The prior authorization tip guide is designed to help practices minimize the burdens caused by prior authorization and increase the efficiency of the process.
Prior authorization webinar
This prior authorization webinar reviews the current industry landscape, provides tips to reduce manual burdens and discusses changes needed to improve prior authorization in the future.