In plain English
What makes it retroactive is the timing. It describes an insurer's approval that comes after the medical service, treatment, or supply has already been provided, rather than in advance.
In context
Here, "retroactive authorization" names an authorization workflow for insurer approval that is referenced after the medical service, treatment, or supply has already been provided.
- Situation
- Checking provider networks, authorization, referrals, eligibility, and preapproval states
- What it communicates
- names an authorization workflow referenced after the usual timing point.
Meaning limits
The term alone does not indicate whether the insurer will grant the approval or what the outcome will be.
Examples
“The insurer gave retroactive authorization for the overnight observation after the patient had already gone home.”
“After the dressing change was done, the surgeon's office requested retroactive authorization from the insurer.”