What is the final step in the prior authorization process?

The final step in the prior authorization process is authorization submission. This crucial phase occurs after all necessary information and clinical documentation have been gathered to support the request for authorization. It involves submitting the completed prior authorization request to the insurance company or payer for their review and approval.

This step is vital because it marks the transition from preparation and documentation to formal communication with the insurer. The outcome of this submission determines whether the requested healthcare service will be approved or denied based on the insurer's criteria. It is essentially the culmination of all previous steps, including patient notification, insurance verification, and any necessary appeals from initial denials. Consequently, successful authorization submission leads to an authorized treatment plan, allowing the patient to receive the needed services without unexpected out-of-pocket expenses.