How does prior authorization differ from “pre-authorized” and “prospective review”?
A. “Prospective review” requires the treating physician to make a request for authorization prior to providing treatment, and if the request was made orally to follow up with a written request within 72 hours. (8 CCR § 9792.6(n)) “Pre-authorization” and “prospective review” have the same meaning in the California workers’ compensation UR system. “Prior authorization” however, does not require a request for authorization to be made prior to providing the treatment in order to be assured that appropriate payment will be made to the treating physician.
