Coverage
Ask which benefit applies, which conditions are covered, and whether limits or exclusions affect the product opportunity. Regulatory approval and insurance coverage answer different questions.
Authorization
Understand the payer criteria and the evidence the provider must submit. A useful request connects the documented clinical facts with the applicable requirements.
Claim and adjudication
Submission quality, coding, timing and benefit conditions can influence the transaction outcome. Separate administrative rejection from a substantive coverage or medical-necessity decision.
Dispensing and continuation
Authorization and claim acceptance do not by themselves establish that treatment was dispensed or continued. Use authorized evidence to investigate the next part of the pathway.
Conceptual guidance, not a statement of current payer policy. Check the current product, benefit and official requirements before action.