What is Prior Authorization?
Definition
Prior authorization (also called pre-authorization or pre-cert) is the process of obtaining approval from an insurance payer before performing a specific service, procedure, or prescribing a medication. The payer reviews the request against medical necessity criteria to determine coverage. Failure to obtain required prior authorization is a leading cause of claim denials.
Why It Matters
Prior authorization requirements have increased dramatically across all payers, with some plans requiring approval for over 30% of all services. The manual process of submitting, tracking, and following up on authorizations consumes significant staff time and delays patient care. For enterprise organizations, managing hundreds of concurrent authorizations creates operational complexity and revenue risk.
How Ventus AI Helps
Ventus AI streamlines prior authorization by automating submission, status tracking, and follow-up across all payer portals. Our AI agents determine authorization requirements proactively, submit requests with supporting documentation, and monitor approvals in real time. This reduces authorization turnaround from days to hours and prevents authorization-related denials.
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