---
title: Authorization and Prior Authorization Terminology
description: Review prior authorization terminology, including approval requests, medical necessity reviews, decisions, and next steps, for interpreted member calls.
---
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# Authorization and Prior Authorization Terminology
## A quick-reference glossary for interpreting conversations about approval requests, review decisions, and authorization requirements.
Authorization processes review requests under a plan’s coverage requirements. A referral, a prescription, and a prior authorization are different documents or decisions and may all be relevant to the same service.
### Requests and review
- Authorization: Approval for a specified service or action; its meaning depends on context.
- Prior authorization: A plan’s advance review or approval required before certain services, items, or medicines are received.
- Preauthorization: Another term commonly used for prior authorization.
- Precertification: A term sometimes used for advance review or approval; specific use depends on the plan.
- Service authorization request: A request for a plan to approve specified care or support.
- Utilization management: Processes used to review the appropriateness and use of healthcare services under applicable criteria.
- Medical necessity review: Assessment of whether a requested service meets applicable clinical and coverage standards.
- Clinical documentation: Health information supporting a request, such as examination findings, diagnoses, or treatment history.
- Requesting provider: The professional submitting or supporting the request.
### Status and decisions
- Pending review: A request awaiting a decision or further processing.
- Additional information request: A request for more documentation before a decision can be completed.
- Approval: A favorable decision for the specified request under stated conditions.
- Partial approval: Approval of some, but not all, requested services or amounts.
- Denial: A decision not to approve all or part of a request.
- Authorization number: A reference identifying an authorization decision or record.
- Authorized units: The approved number or quantity of services or items.
- Authorization period: The time span covered by an authorization.
- Extension request: A request to continue or expand an existing authorization.
### Urgency and follow-up
- Standard review: Review using the usual applicable processing timeframe.
- Expedited review: A faster review available when defined urgency criteria are met.
- Peer-to-peer discussion: A discussion between clinicians about a request or decision, where the plan’s process allows it.
- Appeal: A request to review an unfavorable coverage or payment decision.
- Written decision notice: A document explaining the decision and applicable next steps or rights.
Authorization requirements, review standards, timelines, and follow-up options vary by program and plan. Prior authorization is not an unconditional guarantee of payment. The plan can explain the decision, approved service details, and appeal rights. A peer-to-peer discussion should not be assumed to replace or extend an appeal deadline.
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