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An authorization refers to a verbal or written approval from a managed care organization (MCO), which authorizes the Center for Medicare and Medicaid Services(CMS) to disclose personal health information to persons or organizations that are designated in the approval. An MCO approval is necessary and must be received by a doctor before giving care to the beneficiary.
Prior authorization refers to the approval that a Medicare part D plan member's physician must obtain before using certain medications. Absence of prior authorization will disentitle part D plan member from coverage for the medication.