CGM Monitors will allocate prior authorization once we have all the details about the patient, including their demographics and insurance information. CGM Monitors will acquire the prescription and medical records and contact the insurance company to provoke an authorization request.
Medicare Part B doesn’t demand prior authorization to use a continuous glucose monitor. Medicare also covers therapeutic continuous glucose monitors like the Freestyle Libre 2. Patients who have Medicare Part B insurance do not need to be authorized.
Prior authorization can be used to discourse the need for further clinical patient information. Online adjudication of prescriptions by health plans and prescription benefit management companies (PBMs) has made it more comfortable to administer the DME benefit. However, the information for DME coverage decisions is not always accessible via the online adjudication system. The claims adjudication process does not transmit data such as a patient’s clinical diagnosis and weight, height, laboratory results, non-drug therapy, or over-the-counter medication usage. We can obtain additional information through the prior authorization process.