Which of the following should NOT be included in a claim for prior authorization?

Prepare for the Prior Authorization Certified Specialist Exam. Study with multiple choice questions, each with hints and explanations. Ace your exam with confidence!

The correct choice for what should not be included in a claim for prior authorization is outdated patient medication history. Prior authorization is a process used to ensure that certain medications are prescribed appropriately based on current patient information, treatment guidelines, and insurance policies. An outdated medication history may not reflect the patient's current treatment plan or potential contraindications, making it irrelevant and potentially misleading.

Including current medication information is essential for evaluating the appropriateness of a new treatment or medication based on the patient's actual therapeutic regimen. Therefore, focusing on the most up-to-date records is vital for making informed clinical decisions and obtaining approval from payers.

The other elements listed—such as the diagnosis (ICD-10 code) and previous drug trials—are critical pieces of information that help establish the medical necessity for the requested treatment. Height may also be relevant in certain contexts, particularly for calculating dosage, reflecting the importance of comprehensive data in the prior authorization process.

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