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Prior authorization is a check run by some insurance companies or third-party payers in the United States before they will agree to cover certain prescribed medications or medical procedures. [2] There are a number of reasons that insurance providers require prior authorization, including age, medical necessity, the availability of a generic ...
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Unlike denied claims, rejected claims must be corrected and resubmitted. Failure to address rejected claims can lead to significant revenue loss, making timely rework essential. Step 7: Creating Patient Statements [4] After the payor processes the claim and pays their portion, any remaining balance is billed to the patient in a separate statement.