A definition problem is doing most of the work in this Prior authorisation discussion. Once the term is pinned down I suspect the disagreement mostly goes away and what is left is small.
Prior authorisation: what the criteria usually require — setting out what I have, and where I think it stops being reliable.
A methods question rather than a substantive one, about Prior authorisation.
Everyone quotes the same figure and I cannot find anyone who says how it was arrived at. That is not an accusation; it usually means the derivation is somewhere obvious and I have missed it.
Prior authorisation: pre-approval requirements and how to satisfy them. Most denials cite specific criteria. Understanding the criterion is the first step in satisfying it.
The step people skip is the one I have spelled out.
Keep every document with dates in one place. An appeal months later is assembled from whatever you kept.
Caveat: everything above assumes the paperwork is what it says it is.
Post #3 is the version of this I will quote in future. One addition.
Date every account in this subcategory. Payer criteria change frequently and the archive keeps posts permanently.
That distinction has done more work for me than anything else in this category.
Post #3 describes the usual case. This is about the unusual one.
The number people quote for Prior authorisation is a central estimate presented without its interval, and the interval is wide enough that the estimate is nearly uninformative on its own.
Prior authorisation was covered in the wiki last year and the page has a review date on it, which is a better starting point than my memory of a thread.
Right — I had this wrong and I am glad to have read it before it mattered.
Noted, and I have changed what I was going to do on the strength of it.
My position on Prior authorisation is current rather than settled. I have revised it once already and I expect to again, so treat it accordingly.
The single most useful preparation is obtaining the actual criteria document rather than working from what somebody was told on the phone.
Not the answer, but possibly the question that gets there.
Useful. I had the fact and not the reason, which turns out to be the important half.
The honest answer on Prior authorisation is that it depends, and the useful part is the list of what it depends on. Four items, in rough order of how much they matter.
Most people get the first two right and then argue about the fourth.
Formulary changes happen on a published schedule, so a denial now may be answering criteria that change shortly.
Old habit: I write down the expected answer before I calculate it.
Everything in post #20 holds. The case it does not cover is the one I have.
Prior authorisation criteria are usually published by the payer, and reading them before the appointment changes the outcome more than anything else does.
Adding this to the thread rather than to the wiki, because I am not confident enough for the wiki.
I came in to disagree and I am leaving without a disagreement.
What I want from this Prior authorisation thread is the list of things that would need to be true for the claim to hold. If we can write that list, we can check it.
Answering the question post #23 raises rather than the one it answers.
Where a criterion requires documented prior attempts, the documentation has to exist in the record rather than in your memory of it.
The uncertainty is in the assumption, not in the calculation.
On post #27 — agreed on the reasoning, with one qualification.
What I would check first on Prior authorisation is whether the thing being measured moved or whether the way of measuring it moved. Those look identical in a graph.