Who is responsible for submitting a request for prior authorization for care?

The responsibility for submitting a request for prior authorization for care typically falls on the provider. This is because the provider has the necessary information about the patient's condition and the proposed treatment to complete the request accurately. The provider must ensure that the treatment plan aligns with the insurance policy requirements, demonstrating medical necessity and justifying why the care is required.

While patients may be involved in the process, particularly in circumstances involving their insurance details or obtaining their consent, it is the healthcare provider’s role to initiate the prior authorization to facilitate the patient's access to necessary services. Additionally, the insurance company processes the request after it is submitted, and the billing department generally handles billing and coding, rather than the prior authorization itself.