← Insurance Verification, AnsweredDoes benefits verification tell me if prior authorization is required?
A thorough benefits verification flags prior-authorization requirements per CPT code, for this payer and plan. Obtaining the authorization is a separate process. An eligibility check usually does not surface prior-auth requirements reliably, because they live in payer policies rather than in the 271 response.
Prior-auth requirements are among the facts most likely to be missing from the electronic eligibility response and most likely to cause a denial when missed. They are also payer- and plan-specific, so the same code can require authorization under one plan and not another from the same carrier. Benefits verification that includes a prior-auth flag per code is the practical safeguard.
Last reviewed October 8, 2026
