Retro Authorization refers to obtaining authorization from an insurance company after a service or treatment has already been provided to the patient. This situation may occur when a healthcare provider initially believes that the service is medically necessary but later discovers that retroactive approval is required by the insurance company. Retro authorization is typically more challenging to obtain than prior authorization, as it involves justifying the necessity of the service after it has already been rendered
Prior Authorization on the other hand is a process by which healthcare providers must obtain approval from a patient's insurance company before certain services, treatments, procedures, or medications are provided. Insurance companies require prior authorization to ensure that the requested service is medically necessary and cost-effective. This process helps control healthcare costs and ensures appropriate utilization of healthcare services.