Prior authorizations average 12 minutes of staff time per request, per the 2024 AMA survey. Specialty practices — orthopedics, cardiology, oncology — submit hundreds a month.
That's not administrative noise. That's a real chunk of your clinical staff's week spent on a process designed to delay care and deny coverage.
I can't fix prior authorizations. But some parts of the process are automatable, and it's worth knowing which ones.
What can be automated
Eligibility checks are the first step and almost always done manually — someone logs into a payer portal to verify that the patient is covered and that the specific procedure is covered under their plan. Clearinghouse APIs return this in real time. It's fully automatable.
Form submission is getting more automatable as payers move toward FHIR-based electronic PA. Progress is slow, but EHRs with these integrations can submit structured requests without portal data entry.
Status tracking is pure polling — checking whether an in-flight PA has been approved, denied, or flagged for more information. Schedule it. Get a notification when status changes. Nobody should be refreshing a payer portal manually three times a day.
Denial documentation for appeals is partly automatable. When a PA is denied, gathering the clinical notes and supporting records into an appeal packet can be structured as a workflow, even if the clinical judgment about what to include still belongs to the provider.
What can't
Clinical justification requires a provider. Peer-to-peer reviews require a provider on the phone. There's no automation for those.
Realistic outcome
A PA workflow automation handles eligibility checks, form submission where supported, status polling, and appeal documentation prep. What remains for staff: judgment calls on denials, peer-to-peer coordination, payers without usable APIs (still too many of them). The mechanical parts run in the background. Staff attention goes where it's actually needed.
