What is the first step needed to obtain approval for patient services or procedures?

The correct answer is prior authorization. Prior authorization is a crucial step in the healthcare process that requires a healthcare provider to obtain approval from a payer or insurance company before certain services or procedures are rendered to a patient. This step ensures that the proposed treatment is medically necessary and covered under the patient’s insurance plan, preventing unexpected costs for both the patient and the provider.

Initiating prior authorization involves submitting specific details about the patient's condition, the planned treatment, and the rationale for its necessity based on clinical guidelines. By securing this approval beforehand, healthcare providers can ensure that the patient's care aligns with both medical necessity and payor policies.

Patient history checks, direct referrals, and consultation requests, while important components of patient management, do not directly result in the necessary approval for services. These steps may occur as part of the broader process but do not specifically address the requirement for prior authorization essential for many treatment plans and interventions.