Which payer is described as never allowing prior authorization review?

Which payer is described as never allowing prior authorization review?

• A. Private insurers
• B. Tricare
• C. Medicaid
• D. Medicare

Answer: (C)

Prior authorization is a pre-approval step payers use to confirm medical necessity before covering a test or procedure. In many teaching scenarios, Medicaid is described as not requiring this pre-approval for genetic testing, so it’s seen as never triggering prior authorization review. That means a clinician can order the test and have coverage without going through an authorization process, which is why Medicaid is identified as the payer described in this way. By contrast, private insurers more commonly require prior authorization, and Tricare and Medicare have their own review processes, making them more likely to involve prior authorization in many cases.

Prior authorization is a pre-approval step payers use to confirm medical necessity before covering a test or procedure. In many teaching scenarios, Medicaid is described as not requiring this pre-approval for genetic testing, so it’s seen as never triggering prior authorization review. That means a clinician can order the test and have coverage without going through an authorization process, which is why Medicaid is identified as the payer described in this way. By contrast, private insurers more commonly require prior authorization, and Tricare and Medicare have their own review processes, making them more likely to involve prior authorization in many cases.