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Prior authorization (PA) is a necessary step in the healthcare process. While it was introduced to manage healthcare costs and ensure that the treatments are appropriate, it often causes delays and adds extra paperwork for healthcare providers and patients.

But the good news is that with the right strategies and careful planning, you can make the prior authorization process easier, reduce delays, and help your practice run more smoothly. In this blog, we’ll share simple, practical steps your team can use to handle prior authorizations more effectively.

What is Prior Authorization?

Prior authorization is a process which is used by insurance companies to determine if they will cover a certain treatment, test or medication. The goal is to ensure that the treatment is medically necessary and covered under the patient’s plan.

Furthermore, through prior authorization it is ensured that the patients get the treatment that is proven to be most effective. It can sometimes create delays and extra work for doctors and patients.

How to Streamline Your Prior Authorization Workflow and Reduce Delays?

Do you know? According to the 2024 AMA prior authorization physician survey, physicians complete around 39-43 prior authorization requests every week. That’s nearly one every hour.

Even more concerning, nearly 1 in 3 (31%) of those requests are often or always denied.

These numbers show how important it is to send a clear and well-executed PA request. Doing it right the first time helps you avoid denials, delays, and extra work. Here’s how you can make your prior authorization process flow smoother and faster:

1. Start the Authorization Process Early

Begin the authorization process as soon as you know it’s needed. Early action allows your team time to gather documents, submit the request, and respond to any insurance questions before the patient’s appointment. This prevents delays in care and reduces the chance of needing to reschedule procedures.

2. Understand the Payer-Specific Requirements

Each insurance company has its own list of what needs prior authorization and what documents are required. Keeping a guide or digital cheat sheet for each payer helps your team to send in requests accurately the first time, thereby saving hours of rework and improving approval rates.

3. Use Electronic Prior Authorization (ePA) Solutions

Many clinics and offices now use ePA prior authorization systems to send and track prior authorization requests. These electronic prior authorization platforms can help fill out forms automatically, send them quickly, and keep track of the status. You can also use your clinic’s electronic health record (EHR) system to help speed up the process and include important patient information.

4. Follow Up on Your Request Proactively

Don’t wait too long to hear back from the insurance company. If you haven’t received an update after a few days, follow up through their portal or give them a call.

If your request is denied, it’s better to know right away so you can fix the issue or start an appeal. To keep track of all requests and follow-up dates, you can use ePA prior authorization systems.

5. Have a Strong Appeal Strategy

Sometimes, even when everything is done correctly, the insurance company may still deny your request. When this happens, be ready to appeal the decision quickly and clearly.

Have a simple process in place that includes what to include in the appeal, who to contact, and templates for common cases. Also, track when appeals are sent and when responses are due to avoid further delays.

Final Words

Prior authorization isn’t going away, but delays and confusion don’t have to be part of the process. By staying prepared, using helpful tools, training your staff well, and keeping things organized, you can make the process smoother and help your patients get better care.