Prior auth time per request dropped 83%. The practice shelved plans to hire a second authorization specialist.
Engagement map
From operating problem to measured outcome
4 weeks delivery · 4 tools in the implementation stack
Challenge
This 4-physician practice was running 15–20 prior authorization requests a day.
What we built
We integrated with eClinicalWorks and built a workflow that pulls clinical data from the chart when a prior auth is initiated.
Result
Per-request time dropped from 12 minutes to about 2 minutes, mostly reviewing and clicking submit.
Recorded outcomes
Delivery timeline: 4 weeks. Metrics are shown in the same context as the published engagement.
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.
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.
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 implementation path shown here follows the actual engagement summary.
Implementation sequence
Provider marks a procedure as requiring
prior auth in eClinicalWorks.
Automation detects the flag and pulls
relevant clinical data: procedure code, diagnosis, relevant history.
Payer identified from patient's insurance record
Payer-specific submission template selected.
Form pre-populated with clinical data
Fields needing clinical narrative are flagged for provider input.
Staff reviews the pre-filled form
adds any flagged narrative, approves submission.
Automation submits via the payer's EDI
channel or portal API, whichever is available.
Submission reference number logged back to
the chart. Status set to pending.
Automated status check at 9 AM
and 2 PM. Approval updates chart. Denial creates a review task.
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