Prior authorization (PA) is a process used by health insurance companies to determine if they will cover a prescribed procedure, service, or medication. While it’s designed to control costs and ensure appropriate care, it often adds delays and administrative burden to healthcare providers and staff.
✅ Why Prior Authorization Exists
Insurers use PA to:
- Confirm that a service is medically necessary
- Ensure that lower-cost alternatives have been considered
- Prevent unnecessary or duplicated procedures
While these goals may sound reasonable, the process often leads to delayed treatment, rework, and frustrated patients.
🚨 The Problem with Prior Authorization
- Complexity: Each payer has different rules, forms, and portals.
- Time-consuming: Staff spend hours chasing documentation, faxes, and approvals.
- Denials: Even one small error can result in a claim denial or payment delay.
In fact, a 2023 MGMA survey found that 82% of healthcare leaders say prior auth demands have increased in the last year alone.
🛠️ How to Streamline It
To reduce the burden of PA:
- Use a centralized tracking tool to manage requests across payers
- Standardize your workflows internally with checklists and templates
- Stay up to date on payer-specific requirements
- Follow up proactively and document everything
💡 RCMStreamline Can Help
At RCMStreamline, we help healthcare teams:
- Track and manage prior auth requests in one place
- Prevent denials with payer-specific tips
- Stay organized and compliant
Ready to simplify your workflow?
