Which scenario illustrates a prospective prior authorization?

Which scenario illustrates a prospective prior authorization?

• A. A hospital requests authorization before admitting a patient.
• B. Authorization during inpatient stay to continue services.
• C. Assess care after discharge.
• D. Patient signs a waiver.

Answer: (A)

Prospective prior authorization means getting the insurer’s approval before the service or admission is provided, so coverage and medical necessity are confirmed ahead of time. In this scenario, the hospital requests authorization before admitting the patient, which is exactly obtaining that approval in advance. That forward-planned step distinguishes it from other reviews: concurrent authorization would occur during the stay to continue services, retrospective review happens after discharge to assess what was done, and a patient signing a waiver isn’t insurer-driven approval for services. So this scenario best demonstrates obtaining prior authorization before care is delivered.

Prospective prior authorization means getting the insurer’s approval before the service or admission is provided, so coverage and medical necessity are confirmed ahead of time. In this scenario, the hospital requests authorization before admitting the patient, which is exactly obtaining that approval in advance. That forward-planned step distinguishes it from other reviews: concurrent authorization would occur during the stay to continue services, retrospective review happens after discharge to assess what was done, and a patient signing a waiver isn’t insurer-driven approval for services. So this scenario best demonstrates obtaining prior authorization before care is delivered.