Payer policy
Prior authorization
Payer approval required before a service is performed, without which the claim is denied regardless of medical necessity.
What it means in dermatology
Dermatology encounters it most with biologics, phototherapy, some laser treatments and Mohs on certain plans — particularly Medicare Advantage products that impose requirements traditional Medicare does not.
Authorizations are code-specific and date-limited. An approval obtained for one code will not cover the code actually billed if the plan of care changes.
Why it matters to your revenue
A missing authorization is usually an unappealable write-off, which makes it a scheduling problem rather than a billing problem.
See this term in your own numbers
A free claims audit reviews a de-identified sample of your dermatology claims and returns a line-item findings report — including where terms like this one are costing you money.
Request a free claims audit