What is the difference between preauthorization and concurrent review?

• A. Preauthorization requires no prior approval.
• B. Concurrent review is the initial request; preauthorization occurs during treatment.
• C. Preauthorization is prior approval before service; concurrent review occurs during ongoing treatment to determine continued coverage.
• D. Both terms refer to retrospective reviews.

Answer: (C)

Preauthorization and concurrent review are both utilization-management steps, but they happen at different times in the care process. Preauthorization means obtaining approval before the service is provided. A request is submitted to the payer to confirm medical necessity and coverage before scheduling or performing the procedure, giving the green light in advance.

Concurrent review, on the other hand, occurs during the course of treatment. As care is delivered—such as an inpatient stay or ongoing therapy—the payer reviews the ongoing need and duration to decide whether continued coverage is appropriate. If the treatment remains medically necessary, authorization continues; if not, adjustments or discharge planning may be recommended.

So the key difference is timing and purpose: preauthorization is prior approval before service, while concurrent review is ongoing review during treatment to determine continued coverage.