Prior authorization has become one of the most significant administrative burdens in American healthcare. A 2023 AMA Prior Authorization Physician Survey found that physicians and their staff spend an average of 14 hours per week — nearly two full business days — completing prior authorization requests. More critically, 93% of physicians reported that prior authorization delays have caused treatment delays for their patients, and 33% said these delays have led to serious patient harm.
The financial cost is equally significant. According to CAQH, the average prior authorization transaction costs a provider $11.43 when handled manually — compared to $2.76 when processed electronically. For a practice processing 100 authorizations per month, that is a cost difference of $870 per month, or over $10,000 per year, just from manual processing inefficiency.
The good news is that a combination of process redesign, technology adoption, and payer engagement strategies can dramatically reduce the time and cost of prior authorization — in many cases cutting approval turnaround from multiple days to just hours.
Step 1: Build a Payer-Specific Authorization Matrix
The single highest-impact starting point for streamlining prior authorizations is building a comprehensive payer-specific authorization matrix — a reference document that maps every procedure you commonly perform against every major payer's authorization requirements.
This matrix should capture: which procedures require authorization, which require only notification, which are exempt; the specific clinical documentation required for each; the submission method (portal, phone, fax); and average turnaround times by payer.
Without this reference, staff often waste time calling payers to ask whether authorization is required — or worse, submitting claims for services that required pre-authorization but did not receive it, resulting in automatic denials. Once built, review and update your matrix quarterly to catch payer policy changes before they cause problems.
Step 2: Submit Authorizations Electronically Whenever Possible
Phone and fax-based prior authorization submissions are the biggest time sinks in the process. Electronic authorization submission through payer portals or integrated practice management systems reduces average turnaround time by 40–70% compared to phone submissions, according to CAQH Index data.
Most major commercial payers — Anthem Blue Cross, Aetna, Cigna, UnitedHealthcare — now support electronic authorization submission through their provider portals or through clearinghouse connections. Configure your practice management system to submit electronically to every payer that supports it, and train your authorization staff exclusively on portal submission rather than phone.
For payers that still require phone submission, designate a single experienced staff member as your authorization specialist for that payer. Familiarity with a payer's specific questions and documentation preferences can cut phone call time by 30–40% compared to a generalist approach.
Step 3: Front-Load Documentation Collection
A large percentage of prior authorization delays happen not because the payer is slow, but because the provider's office is slow to supply requested clinical documentation. Payers frequently request additional records — office notes, lab results, imaging reports — before issuing a determination, and each back-and-forth exchange adds days to the process.
Prevent this by front-loading documentation collection before the authorization request is even submitted. Train your clinical staff to attach a standard documentation package with every authorization request: the referring provider's note documenting medical necessity, relevant diagnostic codes and supporting lab or imaging results, and any prior treatment history that supports the requested service.
A complete, well-organized initial submission significantly reduces additional information requests and positions your authorization to be approved on the first review cycle rather than the second or third.
Step 4: Use Real-Time Benefit Tools for High-Volume Services
For practices with high authorization volumes — particularly in specialties like oncology, orthopedics, radiology, and behavioral health — real-time benefit (RTB) tools can provide instant coverage and authorization eligibility information at the point of care.
RTB integrations with payers allow your staff to check authorization requirements and receive preliminary determinations in real time through your EHR or practice management system, rather than submitting a separate authorization request and waiting for a response.
Several major EHR vendors have native RTB integrations built in. If yours does not, third-party solutions like Availity, Surescripts, or Myndshft can bridge the gap. For practices processing more than 50 authorizations per month, the ROI from an RTB investment typically pays back within 60–90 days.
Step 5: Track and Report Authorization Turnaround by Payer
You cannot improve what you do not measure. Build a simple dashboard that tracks authorization submission date, payer response date, approval rate, and denial reason by payer. Review this data monthly.
This data will reveal which payers consistently take the longest, which denial reasons are most common (medical necessity vs. missing documentation vs. non-covered service), and where your internal process is creating delays before the request even reaches the payer.
Use turnaround time data to set realistic scheduling windows — ensuring patients are not booked for procedures before authorization is received — and to prioritize follow-up calls to payers whose authorizations are approaching their expiration date without a determination.
How Vexlo Can Take Authorization Off Your Plate
At Vexlo Medical Billing, we manage the full prior authorization lifecycle for our clients — from eligibility and authorization requirements research through submission, follow-up, and appeals. Our dedicated authorization specialists use electronic submission workflows and payer-specific playbooks to turn most authorizations around in 24–48 hours rather than 3–7 business days.
We serve practices across the United States. If your team is spending too many hours on prior authorizations — or missing authorizations that are causing denials — our team can help you reclaim that time and protect your revenue.
Reach out today to learn more about how Vexlo handles prior authorization as part of our full-service medical billing solution.
