Physicians estimate they spend 14 hours weekly on prior authorization paperwork. For every 40 patients seen, practices submit an average of 31 prior authorization requests. The administrative burden consumes time that could be spent on patient care, while authorization delays frustrate patients waiting for approved treatments.
When authorization requests get denied or delayed, patients face postponed procedures, interrupted treatment plans, medication access problems, and increased anxiety about their care. Practices deal with rescheduling complications, revenue delays, appeals processes, and dissatisfied patients. Prior authorization services address these challenges by managing the entire authorization process from initial submission through approval.
Understanding Prior Authorization
Prior authorization requires healthcare providers to obtain insurance company approval before delivering certain services, procedures, or medications. Insurance companies use this process to control costs by verifying medical necessity before paying for expensive treatments.
Common services requiring authorization include advanced imaging (MRI, CT scans, PET scans), surgical procedures, specialty medications, durable medical equipment, physical therapy beyond initial visits, specialist referrals, and inpatient admissions. The specific requirements vary by insurance company, plan type, and service category.
The authorization process involves gathering clinical documentation supporting medical necessity, completing insurance company forms, submitting requests through appropriate channels (phone, fax, online portal), tracking request status, responding to requests for additional information, and managing denials and appeals when necessary.
This complex process requires understanding each insurance company’s requirements, knowing which services need authorization, recognizing documentation standards that support approval, and tracking multiple requests simultaneously. Most practices lack dedicated staff for authorization management, making it difficult to handle efficiently.
The Prior Authorization Challenge
Administrative Burden
Prior authorization consumes substantial staff time. The typical request requires 20 to 40 minutes when accounting for gathering clinical notes and documentation, completing authorization forms, submitting through insurance portals or fax, following up on pending requests, and documenting authorization outcomes.
For practices submitting 30 authorizations weekly, this represents 10 to 20 staff hours devoted exclusively to authorization work. This burden falls heavily on already busy front office staff managing appointment scheduling, patient check-in, phone calls, and billing tasks.
Treatment Delays
The authorization process typically takes 3 to 10 business days, though complex cases may require several weeks. During this waiting period, patients experience delayed diagnostic imaging, postponed surgical procedures, interrupted medication therapies, and paused treatment plans.
These delays affect patient outcomes, satisfaction, and trust in their healthcare providers. Patients don’t understand why their physician-recommended treatment requires insurance company approval, creating frustration directed at the practice.
High Denial Rates
Insurance companies deny 15% to 30% of initial authorization requests. Common denial reasons include insufficient clinical documentation, services not deemed medically necessary by insurer criteria, missing information on submission forms, requests submitted to the wrong department or plan, and documentation not supporting the requested service level.
Each denial requires appeals with additional documentation, peer-to-peer reviews between physicians and insurance medical directors, and resubmission following specific appeal procedures. The appeals process adds weeks to authorization timelines while consuming more administrative resources.
Revenue Impact
Authorization delays and denials have a direct impact on practice revenue. Services can’t be billed until performed, but performance requires authorization approval. Extended authorization timelines push revenue recognition into future months. Denials that lead to canceled procedures represent lost revenue entirely.
Additionally, practices sometimes proceed without authorization to avoid delays in patient care. When insurance subsequently denies payment, practices face difficult decisions about collecting from patients or absorbing the cost.
How Prior Authorization Services Work
Professional prior authorization services specialize in managing this process efficiently, achieving higher approval rates and faster turnaround than in-house staff can typically accomplish.
Initial Setup and Integration
Implementation begins with understanding practice needs, including which specialties and services require frequent authorization, which insurance companies the practice contracts with, preferred communication methods and reporting formats, and practice management system integration requirements.
The service gains access to necessary systems, learns practice authorization workflows, and establishes communication protocols with practice staff.
Daily Operations
Once operational, the service follows a systematic process:
Request Identification: The service receives information about upcoming services requiring authorization through appointment schedules, physician orders, and treatment plans requiring pre-certification.
Clinical Documentation Gathering: Specialists collect all documentation supporting medical necessity, including relevant clinical notes, diagnostic results, previous treatment records, and physician orders. Understanding what documentation insurers require for approval proves critical for first-time authorization success.
Form Completion and Submission: The service completes insurance-specific authorization forms accurately and submits them through appropriate channels. Many insurers now use online portals for submissions, while others still require phone calls or fax submissions. Experienced authorization specialists know each insurer’s preferences and requirements.
Status Tracking: Active requests get tracked systematically with follow-up at appropriate intervals. Services maintain databases showing each request’s status, submission date, expected decision timeline, and any outstanding information needs.
Additional Information Management: When insurers request more documentation, the service promptly gathers and submits it, preventing unnecessary delays.
Approval Communication: Once approved, the service immediately notifies the practice with authorization numbers and any service limitations or requirements. This information gets documented in the practice management system for billing reference.
Denial Management: When requests get denied, the service reviews denial reasons, determines if an appeal is warranted, gathers additional supporting documentation, and submits appeals following insurer procedures. For complex cases, services coordinate peer-to-peer reviews between practice physicians and insurance medical directors.
Benefits of Professional Prior Authorization Services
Faster Authorization Turnaround
Professional services achieve faster approvals through several advantages. They maintain direct relationships with insurance company authorization departments, understand each insurer’s specific requirements and documentation preferences, submit requests with complete documentation upfront, and follow up proactively rather than waiting for insurer contact.
Practices using professional services report authorization times averaging 3 to 5 days compared to 7 to 12 days for in-house management. Faster approvals mean quicker treatment starts, improved patient satisfaction, better cash flow, and more efficient scheduling.
Higher Approval Rates
Experienced authorization specialists achieve 85% to 95% first-submission approval rates compared to 70% to 85% for in-house staff. This difference stems from knowing exactly what documentation insurers require, understanding medical necessity criteria by service type, completing forms accurately and completely, and submitting through the correct channels.
Higher approval rates mean fewer denials requiring appeals, less time spent on authorization rework, reduced patient frustration, and improved revenue predictability.
Reduced Administrative Burden
Outsourcing authorization work frees practice staff for other responsibilities. Staff previously spending 10 to 20 hours weekly on authorizations can redirect that time to patient care support, improved phone responsiveness, appointment scheduling optimization, and billing functions.
The administrative relief proves particularly valuable for small practices without dedicated authorization staff.
Improved Patient Experience
When authorization processes run smoothly, patients benefit from timely treatment starts, reduced appointment delays, clear communication about approval status, and fewer frustrations with insurance requirements.
Patients appreciate when practices proactively manage authorizations rather than making patients navigate the process themselves.
Revenue Protection
Reliable authorization management protects practice revenue through ensuring services are authorized before performance, reducing denials that delay payment, minimizing the risk of providing non-authorized services, and improving cash flow predictability.
Cost Analysis
Service Investment
| Pricing Model | Typical Cost | Best For |
| Per Authorization | $15-35 per request | Low volume practices (under 15/week) |
| Monthly Flat Rate | $1,200-2,500/month | Consistent volume (15-40/week) |
| Hybrid Model | Base fee + per auth | Variable volume |
Most services charge per authorization completed or offer monthly rates for practices with predictable volumes. For a practice submitting 30 authorizations weekly, monthly flat rates typically provide the best value.
Return on Investment
Professional authorization services deliver value through faster authorization turnaround (3-5 days vs 7-12 days), higher approval rates (85-95% vs 70-85%), reduced staff time spent on authorization work, fewer treatment delays and patient complaints, protected revenue from denied claims, and improved cash flow from quicker approvals.
Practices report that reduced denials alone often justify service costs. Each prevented denial saves $50-100 in administrative costs for appeals and resubmission. Services preventing just 10 denials monthly create $6,000-12,000 annual value beyond direct time savings.
Specialties Commonly Requiring Authorization
Prior authorization services support practices across specialties with high authorization needs:
Cardiology: Stress tests, echocardiograms, cardiac catheterizations, implantable devices, and advanced imaging all frequently require authorization.
Orthopedics: Surgical procedures, advanced imaging (MRI/CT), physical therapy, and durable medical equipment commonly need pre-approval.
Pain Management: Interventional procedures, advanced imaging, specialized medications, and therapy programs typically require authorization.
Oncology: Chemotherapy, radiation therapy, advanced imaging, genetic testing, and expensive medications need pre-certification.
Gastroenterology: Endoscopies, colonoscopies, specialized treatments, and certain medications require authorization.
Neurology: Advanced imaging, specialized testing, expensive medications, and certain procedures need pre-approval.
Selecting the Right Prior Authorization Service
Key Evaluation Criteria
Insurance Company Experience: Verify the service has expertise with your major insurance contracts, including commercial insurers, Medicare Advantage plans, and Medicaid managed care.
Specialty Knowledge: Services familiar with your specialty understand typical authorization requirements, know relevant medical necessity criteria, and can better advocate for approvals.
Technology Capabilities: Assess their ability to integrate with your practice management system, provide real-time status tracking, generate detailed reporting, and communicate through your preferred channels.
Success Metrics: Request information on average turnaround times, first-submission approval rates, appeal success rates, and client retention rates.
Communication Protocols: Understand how they’ll communicate with your practice, including status update frequency, urgent request handling, and approval notification methods.
Implementation Considerations
Successful implementation requires clearly defining which services require authorization, establishing workflows for identifying authorization needs, training staff on communicating with the service, and setting expectations for reporting and communication.
Most services are implemented within 2 to 3 weeks, though complex integrations may take longer.
Making the Decision
Prior authorization services benefit practices dealing with high authorization volumes (15+ weekly), frequent authorization denials or delays, staff overwhelmed with authorization workload, patient complaints about treatment delays, or specialties with complex authorization requirements.
Practices with very low authorization needs (under 5 weekly) may find internal management more cost-effective, though quality and expertise considerations still favor professional services.
The decision balances service costs against staff time savings, reduced denial rates, faster approvals, and improved patient satisfaction. For most practices with significant authorization needs, professional services deliver substantial value while reducing administrative stress.
ScribeRunner provides comprehensive prior authorization services for medical practices nationwide. Our specialized team manages the entire authorization process from initial submission through approval, achieving 85-95% first-submission approval rates and 3-5 day average turnaround times.
Based in Miami, Florida, we serve practices throughout the United States across specialties including Cardiology, Orthopedics, Pain Management, Oncology, Gastroenterology, Neurology, and all major medical specialties.
Prior Authorization Services include:
- Complete authorization request management
- Clinical documentation gathering and submission
- Insurance portal navigation (all major carriers)
- Proactive status tracking and follow-up
- Denial management and appeals processing
- Peer-to-peer review coordination
- Real-time status reporting
Key Benefits:
- 85-95% first-submission approval rate
- 3-5 day average authorization time
- Reduced administrative burden
- Protected revenue through fewer denials
- Improved patient satisfaction
We work with all major insurance companies: Blue Cross Blue Shield, Aetna, Humana, United Healthcare, Cigna, Medicare Advantage plans, Medicaid managed care, and all commercial insurers.
Contact ScribeRunner:
- Phone: (786) 866-7849
- Address: 25 SE 2nd Ave, Suite 1030, Miami, FL 33131
- Hours: Monday through Friday, 8 AM to 6 PM EST
- Service Area: Miami, Fort Lauderdale, Tampa, Orlando, and nationwide
Schedule a free consultation to discuss your practice’s prior authorization needs and receive a custom quote based on your volume and specialty.