A doctor's office calls to say that they have completed the paperwork required by an insurance company to obtain prior authorization, but when you process the prescription through the insurance company's database, it still shows that it is not covered. What step has most likely not been completed?

Question

Quizplus · Accepted Answer

The insurance company most likely has not yet approved the patient's prior authorization request. If the patient's doctor's office has documented the patient's previous treatments properly, the next step in the prior authorization process is for the insurance company to review the doctor's notes and grant or deny authorization. Once this decision has been made by the insurance company, the pharmacy should be notified, or the pharmacy can reprocess the claim to verify coverage.

A Doctor's Office Calls to Say That They Have Completed