Blog

How to Outsource Prior Authorization for Faster Approvals?

Prior authorizations in healthcare can be frustratingly slow and complex. Delays can impact patient care, create administrative bottlenecks, and lead to lost revenue. Outsourcing prior authorization has become an increasingly popular solution to speed up approvals while relieving your internal teams.

Doctor dialogue

Dr. Smith:
“Joe, have you noticed how much time our staff spends just chasing down prior authorizations?”

Dr. Joe:
“Oh, absolutely. It’s becoming a real burden. Some days, it feels like we’re running a paperwork office instead of a clinic.”

Dr. Smith:
“Exactly. I’ve been reading about outsourcing prior authorizations. Apparently, a lot of practices are doing it to speed things up and cut down on admin costs.”

Dr. Joe:
“Really? How does that work? I mean, wouldn’t it be risky handing over patient info to a third party?”

Dr. Smith:
“Good point. But the reputable companies are fully HIPAA-compliant. They specialize in this kind of work — handling payer requirements, submitting documentation, following up. And they usually integrate directly with your EMR.”

Dr. Joe:
“That sounds promising. Honestly, if it could help us get approvals faster and free up our staff to focus more on patients, I’m all for it.”

Dr. Smith:
“Same here. I was thinking maybe we could start with a small pilot — just outsource prior auths for imaging and specialty meds first, see how it goes.”

Dr. Joe:
“I like that idea. Low risk. Plus, if it works, we can scale it up later.”

Dr. Smith:
“Exactly. I’ll set up a meeting with a couple of vendors next week. You in?”

Dr. Joe:
“Count me in. It’s time we got ahead of this prior auth mess.”

Key Takeaways

• Outsourcing prior authorizations streamlines the approval process, reducing turnaround times.

• Specialized vendors bring expertise, technology, and payer-specific knowledge.

• Choosing the right partner ensures compliance, protects patient data, and optimizes workflows.

• Clear communication and integration are key to success when outsourcing.

Why Outsource Prior Authorization?

Prior authorization requirements vary widely across payers, procedures, and medications. Keeping up with changing rules is time-consuming — and mistakes can cause serious delays or denials.

Outsourcing solves this by offering:

• Faster approvals: Dedicated teams specialize in navigating payer portals and escalating requests efficiently.

• Lower administrative burden: Your in-house staff can refocus on patient care and revenue-generating tasks.

• Higher approval rates: Vendors often have inside knowledge of payer preferences, reducing denials and appeals.

• Scalability: Handle surges in volume without needing to hire and train additional staff.

Step-by-Step: How to Outsource Prior Authorization

1. Map Out Your Current Authorization Process

Before handing over prior authorizations to a partner, you need to understand your existing system:

• How are requests submitted?

• Who collects clinical information?

• Where are delays happening?

This insight helps you communicate your specific needs and ensures a smoother transition.

2. Set Clear Objectives

Define what you want to achieve by outsourcing:

• Reduce turnaround time (e.g., approvals in under 48 hours)

• Improve approval rates (e.g., 95% first-pass approval)

• Lower administrative costs

Clear goals will help you choose the right vendor and measure success later.

3. Research and Shortlist Vendors

Not all outsourcing partners are created equal. Look for companies that:

• Have deep healthcare and payer expertise

• Use automation tools to accelerate approvals

• Offer customizable workflows to fit your practice

• Provide full transparency into the status of authorizations

Prepare a shortlist based on these factors.

4. Request a Pilot Program

Before committing fully, ask the vendor to run a small-scale pilot. This will allow you to:

• Evaluate their turnaround time and approval rates

• See how well they integrate with your team

• Spot any gaps before scaling up

A pilot minimizes risk and builds confidence.

5. Define Communication Channels

Seamless communication is critical. Set up:

• A single point of contact on both sides

• Secure ways to exchange patient documents

• Regular update schedules (daily, weekly, etc.)

Clear lines of communication avoid confusion and keep things moving fast.

6. Establish KPIs and Reporting Standards

Make sure the vendor reports on key metrics like:

• Authorization turnaround time

• Approval and denial rates

• Denial reasons and trends

• Time saved for your internal team

Having transparent data helps you continuously optimize the partnership.

7. Train and Transition

Before full launch:

• Train your internal staff on the new workflows.

• Clarify which authorizations will stay in-house (if any).

• Create a smooth handoff process for urgent or complex cases.

what did we learn:

Outsourcing prior authorizations is no longer just a convenience — it’s a strategic move that can significantly improve efficiency, reduce administrative strain, and enhance patient care. By partnering with the right vendor, healthcare providers like Dr. Smith and Dr. Joe can reclaim valuable time, minimize approval delays, and refocus on what truly matters: delivering quality care to their patients.

With clear communication, secure processes, and a commitment to continuous improvement, outsourcing prior authorization can transform a major operational challenge into a competitive advantage.

what people are asking?

 Is outsourcing prior authorization secure?
 Yes, reputable vendors are HIPAA-compliant and use encrypted systems to protect patient data.

How soon will we see faster approvals?
 Many practices notice improvements within 30–60 days after outsourcing.

 Can we outsource only certain services?
Yes, you can choose to outsource specific types like imaging, specialty meds, or high-volume services.

 Will we still control the process?
 Absolutely. You maintain full visibility with regular updates and reporting from your vendor.

 How do we pick the right partner?
 Look for experience, strong references, compliance with regulations, and smooth system integration.

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.