Prior authorization

An insurer approval process required before specified medical services, procedures, or treatments will be covered by the health plan; denials arising from prior authorization determinations implicate the statute's review and signature requirements.

Prior authorization mandates that state entities and employees obtain explicit approval from the Georgia Technology Authority (GTA) before regularly using generative AI tools for organizational purposes. This requirement ensures controlled and compliant integration of AI.

A process required by health insurance carriers where approval must be obtained before a medical service, treatment, or prescription drug is covered.

A written or oral determination made by a health benefit plan provider that a health care service is a benefit covered under the applicable health benefit plan which, under the enrollee's clinical circumstances, is medically necessary or satisfies another requirement imposed by the health benefit plan provider or law and thus satisfies the requirements for payment or reimbursement.

Prior authorization refers to the process by which a healthcare provider must obtain approval from a patient's health plan or utilization review agent before a service or medication can be provided or covered. This process is central to the Act's regulatory scope, as it seeks to reform the criteria, timelines, and methods by which these approvals are granted or denied.