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How to outsource prior authorization services for medical practice?

Managing prior authorizations in-house can be one of the most time-consuming and frustrating tasks for any medical practice. From dealing with multiple insurance carriers to gathering medical documentation, the process often delays patient care and overwhelms staff.

If your team is constantly tied up with phone calls and paperwork, outsourcing prior authorization (PA) services might be the solution you need. This guide walks you through the step-by-step process of outsourcing PA, what to expect, and how to choose the right partner without losing control of your workflow.

Why Consider Outsourcing Prior Authorization?

Before jumping into how to outsource, it’s important to understand why so many practices are doing it:

• Staff members spend valuable time navigating insurance portals instead of assisting patients.

• Delays in approvals can disrupt treatment timelines.

• Incorrect or incomplete submissions can lead to claim denials.

• Hiring and training in-house authorization staff is costly and time-consuming.

Outsourcing allows you to delegate this complex task to experts who specialize in the nuances of insurance verification and authorization. This leads to faster approvals, fewer errors, and more time for your staff to focus on patient-facing duties.

Step-by-Step: How to Outsource Prior Authorization the Right Way?

Step 1: Analyze Your Current Workflow

Start by reviewing your existing PA process. Ask these key questions:

• How many prior authorizations are submitted each week?

• Who is responsible for each part of the process?

• Where are the bottlenecks?

• How long does it typically take to complete an authorization?

This assessment will help you pinpoint which parts of the process are best suited for outsourcing.

Step 2: Identify What to Outsource

You don’t have to outsource everything. Many practices start with:

• Initial authorization submission

• Insurance follow-ups

• Medical necessity documentation gathering

• Appeals and resubmissions

• Status tracking and reporting

You can scale up the scope based on performance and comfort level.

Step 3: Choose the Right Outsourcing Partner

Selecting the right partner is crucial. Here are essential qualities to look for:

• Healthcare Expertise: Look for companies with experience in your specific medical specialty.

• Compliance: Ensure they are HIPAA-compliant and trained in handling protected health information.

• Technology Compatibility: Can they work with your EHR system? (e.g., Athenahealth, eClinicalWorks, AdvancedMD)

• Availability: Do they offer coverage during your working hours or 24/7 service?

• Turnaround Time: Ask about their average response time for approvals and denials.

• Client References: Request testimonials or case studies from other providers they’ve supported.

A reliable example is Staffingly, Inc., a healthcare outsourcing partner that handles prior authorizations with fast turnaround and cost savings. You can contact them at support@staffingly.com or call (800) 489-5877.

Step 4: Set Clear Processes and Training

Your outsourcing partner should function as an extension of your team. Provide them with:

• Standard operating procedures (SOPs)

• A list of common procedures requiring PA

• Sample documentation

• Insurance preferences

• Communication protocols for urgent or denied requests

Establish a clear workflow with checklists, escalation points, and scheduled reporting. Use secure communication tools to share files and updates.

Step 5: Maintain Communication and Quality Control

Even after onboarding, continue monitoring performance. Schedule weekly or bi-weekly check-ins to review:

• Open and closed requests

• Rejection reasons and appeals

• Changes in payer requirements

• Documentation improvements

Use this feedback loop to fine-tune processes and ensure continued success.

Step 6: Monitor Key Metrics

To evaluate success, track the following:

• Percentage of authorizations approved on the first attempt

• Average turnaround time per request

• Number of appeals or re-submissions

• Time saved by in-house staff

• Impact on patient scheduling and satisfaction

A good outsourcing partner should help you improve all of these metrics within 30 to 60 days.

What Did We Learn?

Outsourcing prior authorization services is not about handing over control—it’s about working smarter. It allows your staff to spend more time on clinical and patient-facing tasks while ensuring that authorizations are handled with expertise and efficiency.

When done right, outsourcing helps reduce claim denials, speed up treatment approvals, and boost staff morale.

To summarize:

• Evaluate your internal process first.

• Start with outsourcing the most repetitive or time-consuming tasks.

• Choose a HIPAA-compliant partner experienced in your specialty.

• Maintain regular communication and performance monitoring.

• Use data to measure success.

What People Are Asking? 

Will I lose visibility if I outsource this function?
No. A quality vendor will provide regular updates, reports, and logs so you can track the status of every request in real-time.

Is it secure to share patient data with an outside company?
Yes, as long as the company is HIPAA-compliant and follows strict privacy protocols.

Can they work within my EHR?
Most experienced vendors can adapt to your software platform. Just confirm this during the selection process.

Can I start small?
Absolutely. You can begin by outsourcing a portion of your PA volume to test the waters.

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.