📋 Prior Authorization

2 / 518 min

📋Module 5 · Slide 16

The Prior Authorization Process — Step by Step

Getting an auth approved comes down to a disciplined five-step process. Your job is to help referral sources understand what we need and why — so they send complete packets the first time.

The 5-Step PA Process

Step 1: Verify Coverage

Understand the payor's specific rules, formulary, and step therapy requirements

Step 2: Gather Clinical Documentation

Collect all required clinical records from the referring provider — often the slowest step

Step 3: Submit with Tracking Number

Submit the complete request and always get a tracking number for follow-up

Step 4: Proactive Follow-Up

Follow up proactively and respond quickly to any requests for additional information

Step 5: Communicate Outcome

Communicate the result and manage any denials with appeals or peer-to-peer reviews

Your Role in the PA Process

This process protects our revenue and keeps patients on therapy. As a sales rep, you're the coach for your referral sources — helping them understand what documentation we need and why, so the process moves as fast as possible.