Both involve patient data and insurance IDs. Both touch the payer. But they answer completely different questions, and conflating them is one of the most common mistakes in health tech product design.
The answer depends on the drug, the payer, the plan type, and the patient's clinical history. Here's how prior auth requirements actually work, and what health tech teams need to build for.
Most CoverMyMeds guides are written for hospital staff. This one is for engineering teams building prior auth submission workflows at scale — and where every approach eventually breaks.
Most teams start with Playwright. It works for the first 50 submissions. Then production finds the edges. Here's exactly where they are.
There are three ways to submit a prior authorization: phone, fax, and payer portal. One of them gives you real-time status, costs less per case, and can be automated. Here's how.