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How Long Does Prior Authorization Take & How Staffingly Speeds It Up?

The healthcare landscape can be daunting, especially when it comes to understanding insurance requirements like prior authorizations. These are formal approvals that insurance companies often require before they agree to cover certain medications, treatments, or procedures particularly those with lower-cost alternatives. While the intent behind prior authorizations is to manage costs and ensure medical necessity, the process itself can introduce delays and challenges for both patients and healthcare providers. It involves multiple steps, from identifying which services require prior approval to submitting documentation that demonstrates the medical necessity of the requested treatment.

How does prior authorization work?

The current prior authorization process typically resembles the following flow:

The prior authorization process begins when a healthcare provider determines that a patient requires a specific procedure, test, medication, or medical device. The provider must then review the patient’s insurance plan rules or formulary to check whether a prior authorization is necessary. If it is, the provider must complete and sign a formal request form, attesting that the information submitted supports the medical necessity of the treatment. Due to limited integration between clinical and billing systems, staff typically review these requirements manually, relying on documents like PDFs, paper files, or payer web portals. Unfortunately, these rules vary significantly between insurers and even between plans under the same insurer and they change frequently. As a result, administrative teams may unknowingly rely on outdated information, increasing the risk of errors.

When a service does not require prior authorization, the provider can submit the claim, though approval is still not guaranteed. If authorization is required, the provider must gather detailed information, including the appropriate CPT codes, and request a prior authorization number from the payer to include in the final claim. This step often involves a manual, time-consuming exchange of phone calls, faxes, and emails. It is the provider’s responsibility to monitor the request and follow up until a resolution approval, redirection, or denial is reached. Because this process is largely unstructured and often improvised, it consumes valuable time and resources that could otherwise be directed toward patient care.

Key takeaways:

• Prior authorizations are required by insurance companies for some medications. This includes those that may have less expensive alternatives.
• The prior authorization process can take anywhere from a couple days to a few weeks. Once approved, the prior authorization lasts for a defined timeframe.
• You may be able to speed up a prior authorization by filing an urgent request. If you can’t wait for approval, you may be able to pay upfront at your pharmacy and submit a reimbursement claim after approval.

How long does a prior authorization take?

Depending on the complexity of the prior authorization request, the level of manual work involved, and the requirements stipulated by the payer, a prior authorization can take anywhere from one day to a month to process. The 2018 American Medical Association (AMA) Prior Authorization Physician Survey revealed that 26% of providers report waiting 3 days or more for a prior auth decision from health plans.

This delay can cause problems for both patients and the healthcare professionals attending to them. Patient adherence to medication and treatment often declines when obstacles like postponements or additional steps are introduced. It also siphons off time from clinicians  and the revenue cycle team that supports them that could be better spent on patient care. As an unintended side effect of delayed care while a preauthorization is reviewed, some patients will seek treatment at an emergency room; a decision that will often result in them receiving a large, unexpected bill not covered by their health plan.

Is it possible to speed up prior authorization?

One of the primary reasons that prior authorizations take so long to resolve is that incomplete or incorrect information is submitted to the health plan, which triggers a denial and lot of manual reworks on the provider side.

Any errors contained in the prior authorization form, from egregious to innocuous, may flag it for denial. A number on a patient’s health ID card may be transposed. A middle initial may be incorrectly input. An address may be incomplete.

Errors often arise because the prior authorization process can be overly complicated and often involve a lot of manual steps and stakeholders, which can make it ripe for mistakes. Information about the patient, the ordering provider, the requested service, and the medical scenario are required and if any of it is amiss, it will precipitate a denial. Once a denial has been rendered, it is difficult to reverse.

Even when there are no errors, lengthy medical reviews associated with prior authorization can delay care and introduce uncertainty into the process for both providers and patients. This is especially true when benefit managers are involved.

Automating the end-to-end prior authorization process as early in the revenue cycle as possible reduces the likelihood for errors, lessens the amount of manual work wasted on tedious tasks, and accelerates patient care.

How Staffingly Helps With The Prior Authorization?

• Provides trained remote staff to manage the entire prior authorization workflow from initiation to resolution.

• Reviews insurance plan rules and formularies to determine whether prior authorization is required for a procedure, test, medication, or device.

• Minimizes errors by staying updated with constantly changing, non-standardized payer rules and policies.

• Completes and submits prior authorization request forms accurately, ensuring medical necessity documentation is thorough and compliant.

• Tracks down required CPT codes and payer-specific details to support each request.

• Handles follow-up communications with payers via phone, fax, and email to ensure timely resolution approval, redirection, or denial.

• Reduces administrative burden on in-house clinical and billing teams, allowing them to focus on patient care.

• Decreases turnaround time and denials by avoiding incomplete or incorrect submissions.

• Enhances claim success rates and accelerates patient access to treatments by managing prior authorizations efficiently.

• Contributes to overall revenue cycle improvement by streamlining one of its most time-intensive processes.

What Did We Learn?

Staffingly provides a vital solution to one of the most time-consuming and error-prone administrative processes in healthcare: prior authorization. By offering skilled remote professionals who are trained in navigating payer-specific rules and completing accurate documentation, Staffingly helps reduce delays, improve approval rates, and ensure patients receive timely access to the care they need. This alleviates the burden on in-house clinical and billing teams, allowing them to focus more on patient outcomes rather than paperwork.

Through proactive follow-ups, real-time updates, and error-free submissions, Staffingly transforms an often chaotic and manual workflow into a structured, efficient process. Whether it’s obtaining CPT codes, managing payer communications, or tracking resolution statuses, Staffingly’s support ensures smoother revenue cycle operations and better overall service delivery for both providers and patients.

What People Are Asking?

Q: Does Staffingly help check if prior authorization is required?
Yes, our team reviews payer rules and formulary guidelines to confirm if prior authorization is needed.

Q: Can Staffingly submit prior authorization requests on our behalf?
Yes, trained staff accurately complete and submit all necessary documentation.

Q: How does Staffingly reduce authorization delays?
We follow up proactively with payers and ensure all submissions are complete and accurate.

Q: Do you help with CPT code identification and validation?
Yes, our team ensures correct CPT codes are matched and submitted with the request.

Q: Will Staffingly handle communications with insurance companies?
Yes, we manage all communications phone, fax, or email until the case is resolved.

Disclaimer

For informational purposes only; not applicable to specific situations.

For tailored support and professional services,

Please contact Staffingly, Inc. at (800) 489-5877

Email : support@staffingly.com.

About This Blog : This Blog is brought to you by Staffingly, Inc., a trusted name in healthcare outsourcing. The team of skilled healthcare specialists and content creators is dedicated to improving the quality and efficiency of healthcare services. The team passionate about sharing knowledge through insightful articles, blogs, and other educational resources.