ModeratePayer Initiated (PI)Prior Authorization
PI-15: Authorization required (payer initiated)
The payer has initiated this adjustment because prior authorization was required but not obtained. The PI group code indicates this is a payer-initiated reduction, meaning the provider may have limited appeal rights depending on the contract.
Common Causes
- Service required PA per payer medical policy and none was obtained
- PA was obtained but not linked to the claim correctly
- Payer retroactively added PA requirements for this service
How to Resolve PI-15
- 1Verify if PA was actually obtained -- check authorization records
- 2If PA exists, resubmit with the authorization number
- 3If no PA was obtained, check if retrospective authorization is allowed
- 4File a formal appeal if you believe PA was not required at the time of service
How to Prevent PI-15 Denials
- Check PA requirements at time of scheduling using current payer rules
- Subscribe to payer medical policy updates to catch new PA requirements
- Automate PA requirement checks for all scheduled services
Related Denial Codes
Stop Denials Before They Happen
Greenlight automatically checks prior authorization requirements and submits PA requests before the service is rendered -- eliminating authorization denials entirely.
See How It Works