Reference library
The complete process, from establishing whether an authorization is required through to the remittance, written for the people who do this work rather than for people selling to them. 28 articles, about 74 minutes end to end.
These are reference explainers and carry no publication date. Where a regulatory claim is made, the source is named in the article so you can check it rather than take our word for it.
What prior authorization is, who requires it, and which rules apply to which plan.
Eligibility, medical necessity, documentation, and the transaction itself.
What happens inside the payer, how to read the answer, and what to do while it pends.
Appeals, the path from authorization number to paid claim, and what to do when the plan changes.
CMS-0057-F, gold carding, and delegated utilization management.
How an agent is constrained when the consequence of being wrong is a patient's procedure.