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.

The PA process involves determining if a proposed treatment for a specific condition is covered by the current payer guidelines/standards. To do this, the provider may submit a request to the payer to determine if prior authorization is required before providing a specific treatment for a condition where that treatment is expected to be covered/paid by the payer. The payer then responds to the provider with an indication that prior authorization is or is not required. Convert FHIR to 278 and 278 Response to FHIR, Handle 275 Attachments


Loop 2000E, Segment CRC a. Ambulance Certification b. Chiropractic Cerfication c. Durable Medical Equipment d. Oxygen Therapy Certification e. Functional Limitations f. Activities Permitted g. Mental Status
Loop 2000E, Segment CR1 - Ambulance Transport
Loop 2000E, Segment CR2 - Spinal Manipulation Service
Loop 2000E, Segment CR5 - Home Oxygen Therapy
Loop 2000E, Segment CR6 - Home Health Care
Loop 2010EB - Patient Event Transport
Loop 2000F, Segment SV3 - Dental Service