What is the purpose of a preauthorization process?

• A. To verify benefits after the service is already delivered.
• B. To assess the provider's credentials.
• C. To confirm coverage and medical necessity before services are provided.
• D. To determine patient eligibility for discounts.

Answer: (C)

Preauthorization is used to confirm coverage and medical necessity before services are provided. By reviewing the proposed treatment in advance, the insurer decides whether the care is covered under the patient’s plan and whether it’s medically appropriate and necessary, helping ensure proper payment and appropriate care from the start. Verifying benefits after the service is delivered relates to claims processing, not preauthorization. Credentialing assesses a provider’s qualifications, not whether a treatment should be approved beforehand. Determining patient discounts concerns pricing, not medical necessity or plan coverage.