← All glossary termsPayer Medical Policy
The specific clinical criteria and documentation requirements a health plan uses to evaluate prior authorization requests, which vary payer to payer and often change without notice.
What it means
Keeping up with payer medical policy changes in real time is one of the hardest operational problems in prior authorization, since policies update on the payer's own schedule with little advance notice to providers or vendors. Automation that can't track these changes quickly becomes a liability rather than an asset.
