Who is primarily responsible for initiating the prior authorization request?

The service provider is primarily responsible for initiating the prior authorization request because they are the ones who are familiar with the clinical aspects of the patient's care. They have the technical knowledge of the treatment or service being requested and are in the best position to assess whether the procedure or medication is medically necessary. This responsibility typically includes gathering the required documentation, providing the relevant medical information, and submitting the authorization request to the insurance company.

While other parties, such as nurses, patients, or prior authorization specialists, may play supportive roles in the process, it is the service provider who takes the lead in initiating the request based on their professional expertise and understanding of the patient's needs. This ensures that the information submitted is accurate and sufficiently detailed to facilitate the review by the insurance provider.