What outcome is associated with the use of effective pre-authorization?

• A. Increased wait times
• B. No effect
• C. Higher satisfaction
• D. Reduced claims denials

Answer: (D)

Pre-authorization is the process of obtaining payer approval before a service is provided to verify coverage and medical necessity. When this review is done correctly, it catches issues that would otherwise lead to the claim being denied after submission, such as services not covered, improper coding, or lack of justification. By ensuring the service is approved up front, the likelihood of claims denials drops significantly, which improves reimbursement, reduces administrative rework, and speeds cash flow. While a well-managed pre-authorization program can also contribute to smoother scheduling and even patient peace of mind, the most direct and reliable outcome associated with it is reduced claims denials.