How does prior authorization differ from retrospective review?
A. Prior authorization, by definition, means the treatment is automatically authorized when the conditions of the prior authorization program are met. Retrospective review is review of an RFA after the treatment has already been given. Usually, the review of a doctor’s first report of occupational injury or illness in utilization review involves both retrospective review of some treatment already given (i.e. during the first visit), as well as prospective review for additional treatment to be given as described in the treatment plan.
