How to speed up insurance prior authorization?
Asked by: Karina Wilkinson | Last update: June 14, 2025Score: 4.4/5 (51 votes)
- Create a master list of procedures that require authorizations.
- Document denial reasons.
- Sign up for payor newsletters.
- Stay informed of changing industry standards.
- Designate prior authorization responsibilities to the same staff member(s).
Can I speed up a prior authorization?
Leverage a payer's peer-to-peer process. Speaking with the insurer's medical director or other physician available to speak with physicians about prior authorization issues can clear up problems much faster.
How long does it take for insurance to process a prior authorization?
Taking into consideration the complexity of a prior authorization request, the prior authorization process selected by a healthcare provider, requirements set out in individual health plans, and any subsequent appeals process, a prior authorization (PA) can take anywhere from same day to over a month to process.
How to improve prior authorization process?
Ways to improve prior authorization in California include requiring payers to use automated systems for prior authorizations and limiting how often prior authorization is needed for ongoing treatments.
Why is my prior authorization taking so long?
But even when you're confident that you need to get pre-authorization, the manual process for your practice staff takes time. And because the forms and details regularly change as well, this often leads to delays. You might be able to obtain prior authorization within 24 hours.
Encore: Prior Authorization Process Overview
Can I call my insurance about a prior authorization?
The patient or their representative can contact their insurance company and provide the relevant information to start the Prior Authorization process. It's best to confirm with the healthcare provider if they have the information and are willing to submit the request.
Why is it taking so long for my prescription to be approved?
They review your medical information and PharmaNet profile to check for possible problems. This may include allergies or interactions with other medications you are taking.
How much time do physicians spend on prior authorization?
A 2022 American Medical Association (AMA) survey found that, on average, practices completed 45 prior authorizations per physician per week, with physicians or their staff devoting nearly 14 hours each week to these tasks.
Why is it so hard to get a prior authorization?
Insurance companies can deny a request for prior approval for reasons such as: The doctor or pharmacist didn't complete the necessary steps. Filling the wrong paperwork or missing information such as service code or date of birth. The physician's office neglected to contact the insurance company due to a lack of time.
How do you fight a prior authorization denial?
Once you have a reason for the denial, it's time to partner with your physician's office. Give them the reason for the denial and see if there is any additional information they can provide to support the prior authorization request. Get copies of your consult notes, test results and any additional information needed.
Why would insurance deny a prior authorization?
A denied prior auth request can occur when a provider's office submits a wrong billing code, misspells a name or makes another clerical error. Requests can also be denied if the prior auth request lacks sufficient information about why the medication or treatment is needed.
How long does prior authorization take for medication at United healthcare?
We typically decide on requests for prior authorization for medical services within 72 hours of receiving an urgent request or within 15 days for non-urgent requests.
How long does a prior authorization take for Aetna?
Once your doctor sends a request for prior authorization, Aetna reviews the request. During our review, we look at the most recent and highest quality medical research and guidelines. We update your care provider throughout the review process to keep them informed on the status, and come to a decision within 14 days.
What percent of prior authorizations are denied?
More than a quarter of physicians (27%) reported prior authorization requests are often or always denied, and more than four in five (87%) reported prior authorization requirements lead to higher overall use of resources that result in unnecessary waste.
Can a doctor's office charge for prior authorization?
Physicians and other healthcare providers do not usually charge for prior authorizations. Even if they wanted to, most contracts between providers and payers forbid such practices. However, there are some instances — such as when a patient is out of network — that it may be appropriate to charge for a prior auth.
How do I avoid prior authorization denial?
Understand Insurance Requirements Early On
One of the most common reasons for prior authorization denials is misunderstanding the insurance company's specific requirements. Each insurer has its own set of rules and criteria for approving certain treatments, medications, and procedures.
How do I expedite a prior authorization?
- Create a master list of procedures that require authorizations.
- Document denial reasons.
- Sign up for payor newsletters.
- Stay informed of changing industry standards.
- Designate prior authorization responsibilities to the same staff member(s).
How long should a prior authorization take?
How long does the prior authorization process take? It typically takes 24 to 72 hours.
Why does insurance authorization take so long?
Many things. Maybe their doctor didn't know they needed to complete a prior authorization form for this patient, for this drug. Maybe the pharmacy didn't receive the form. Or maybe the insurer decided they needed additional information before they could issue an approval.
Can you bill for time spent on prior authorization?
"What that means is when using these CPT codes, you can bill for prior authorization." Specifically, the code descriptions sayopens in a new tab or window that doctors can bill for time spent when they, "in concert with the clinical staff, complete prior authorizations for medications and other orders."
Can patients do their own prior authorization?
Some plans allow patients to file their own prior authorizations, but most often this is a process that must be initiated with the doctor's office. Often your doctor will have an idea that the healthcare you need is likely to require this extra step.
What triggers a prior authorization?
Under medical and prescription drug plans, some treatments and medications may need approval from your health insurance carrier before you receive care. Prior authorization is usually required if you need a complex treatment or prescription. Coverage will not happen without it.
How long does it take for insurance to approve a prescription?
A prior authorization is the insurance plan's way of making sure that your medication is needed and appropriate to treat your condition. The prior authorization process can range from a few days to a few weeks. Be sure to talk to your doctor and your pharmacist if you need your medication right away.
How can I get my prescription faster?
Call your healthcare provider's office ahead of time if you need more refills. This will help make sure you receive your medication in a timely manner. You can also call the pharmacy before you pick up your prescription to make sure it's ready when you get there.
Can a pharmacist override a doctor's prescription?
Can a pharmacist change prescriptions? In most cases, a pharmacist must follow the doctor's exact prescription, but there are a few exceptions. If the pharmacist finds interactions, dosing instructions, or other factors preventing the medication from working, a change may be necessary.