Introduction
Delays in the prior authorization process can bottleneck everything from patient care to reimbursement. A chaotic workflow leads to missing documentation, unclear timelines, and denials that stall cash flow. But it doesn’t have to be this way.

Let’s break down how to build a rock-solid, repeatable prior authorization workflow that ensures faster approvals and happier teams.

Step 1: Map Out Your Current Workflow

Use a whiteboard or tool like Lucidchart or Miro to document:

• Who initiates the auth

• Which forms are used

• Where the payer contacts live

• Hand-off points (e.g., front desk → auth team)

Why it matters: Visualizing your existing process reveals inefficiencies and bottlenecks.

Step 2: Create a Standard Operating Procedure (SOP)

A simple SOP should include:

• Auth triggers (e.g., CPT/HCPCS codes or payer policies)

• Required documentation

• Submission method (fax, portal, API)

• Timeline expectations

• Escalation path

Example: For Medicare Advantage plans, specify that all Part B infusions must be submitted within 48 hours with supporting documentation from the provider.

Step 3: Implement a Tracking Tool

Use an Airtable or Excel dashboard (or your tool at RCMStreamline.com) to:

• Log auth requests

• Set due dates

• Assign ownership

• Monitor response status

Pro Tip: Color-code statuses (e.g., “Pending,” “Approved,” “Denied”) to quickly spot problems.

Step 4: Set Daily Checkpoints

Have a designated time (e.g., 10:00 a.m.) to:

• Review auth requests submitted the previous day

• Confirm documentation completeness

• Follow up on overdue requests

Why it matters: This keeps things moving before issues turn into denials.

Step 5: Automate Where You Can

Use:

• RPA bots to scrape portal status

• Fax parsing software (like Updox or Inofile)

• Pre-check tools to identify auth needs at scheduling

Step 6: Communicate with Providers

Delays often stem from missing clinicals or signature issues. Build a fast feedback loop:

• Use secure email templates

• Add clear checklists for providers

• Consider a shared drive for documentation uploads

Step 7: Measure and Refine

Track:

• Avg. time from order to submission

• Approval rate on first attempt

• Denials due to auth issues

Review monthly and update your SOP accordingly.

Conclusion
An optimized prior authorization workflow is one of the biggest levers in your revenue cycle. It minimizes delays, builds payer trust, and saves your team hours of rework. Implement even half of these strategies and you’ll see dramatic improvements in your approval timelines.

Need help creating an optimized prior authroization workflow contact us at support@rcmstreamline.com