Existing Wording: Prior authorization (PA) is performed in the United States by payers and providers to ensure that patients/members receive care and coverage of treatments, testing, referrals, devices appropriate for their specific conditions and the general coverage provided by the specific health plan in which the member is enrolled.

Proposed Wording: Prior authorization (PA) is a process used in the United States that requires providers to receive advanced approval from payers before care delivery to ensure that patients/members receive treatments, testing, referrals, and devices appropriate for their specific conditions and that are covered by the specific health plan in which the member is enrolled.

Comment:

New wording offered to clarify and correct existing text.

Summary:

New wording offered to clarify and correct existing text.