Existing Wording: The PA process involves determining if a proposed treatment for a specific condition is covered by the current payer guidelines/standards. To do this, the provider may submit a request to the payer to determine if prior authorization is required before providing a specific treatment for condition where that treatment is expected to be expected to be covered/paid for by the payer. The payer then responds to the provider with an indication that prior authorization is or is not required.

Proposed Wording: The PA process involves determining if a proposed treatment for a specific condition is covered by the current payer guidelines/standards. To do this, the provider may submit a request to the payer to determine if prior authorization is required before providing a specific treatment for a condition where that treatment is expected to be covered/paid for by the payer. The payer then responds to the provider with an indication that prior authorization is or is not required.

Comment:

Suggested text revision

Summary:

Suggested clarifying text change