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Prior Authorization Insights
A missing auth is an automatic denial no appeal fully fixes. These insights are about getting authorization right before the service happens.
Auth before service, always
Prior-auth denials (CO-197) are among the most preventable. Verify whether auth is required, capture the number, and document medical necessity up front so the claim is clean.
Frequently asked questions
What if service already happened without auth?
Retro-authorization is sometimes possible with strong medical-necessity documentation.