Cutting Prior Authorization Time from 12 Minutes to Under 2

Baseline, method, result

1. Baseline

   This 4-physician practice was running 15–20 prior authorization requests a day. Each one required a staff member to pull the patient chart, gather clinical information, find the payer's form, fill it out, submit it, and log the submission, about 12 minutes per request when everything went smoothly. That was over 3 hours of front-office time daily on work that was almost entirely copy-paste.

2. Method

   We integrated with eClinicalWorks and built a workflow that pulls clinical data from the chart when a prior auth is initiated. The automation pre-populates payer-specific submission requirements (we built templates for their top 6 payers), submits via EDI or portal depending on the payer, and logs the submission with a reference number. Status checks run automatically twice daily and update the chart. Denials create a follow-up task.

3. Result

   Per-request time dropped from 12 minutes to about 2 minutes, mostly reviewing and clicking submit. Daily prior auth work went from 3+ hours to roughly 40 minutes. The practice had been budgeting for a second authorization specialist. That position was shelved, saving an estimated $55–65k annually.

The authorization workflow, step by step

The implementation path shown here follows the actual engagement summary.

Implementation stack

• n8n
• eClinicalWorks
• Eligibility verification APIs
• FHIR APIs