Does Your Procedure Need Prior Authorization?

Prior authorization (prior auth) is a requirement from health insurance companies that providers must obtain approval before performing certain medical services. The insurer reviews the request to determine if the service is medically necessary and covered under the patient's plan.

Whether a procedure needs prior authorization depends on several factors: the specific CPT code, the patient's insurance company and plan, the clinical indication, and sometimes the care setting. Even common procedures like MRI scans and CT scans frequently require prior auth from most major insurers.

The prior authorization process can be time-consuming and complex. Each insurer has different requirements, documentation standards, and submission portals. Incomplete submissions are the leading cause of PA delays and denials. Greenlight Medical automates this entire process, detecting when PA is needed, assembling the required documentation, and submitting directly to the payer.