Which Prior Authorizations Survive Into the New Plan Year?
How to Keep the New Year From Voiding Your Standing Approvals
The goal is simple: no patient loses an active therapy on January 1 because an approval expired that nobody was tracking. Here is what does that, move by move.
1. Pull a November Panel Audit of Every Active Authorization
Before you renew anything, you need a list. Pull every active prior authorization on the panel and tag each one with three facts: the therapy, the expiration date, and the plan’s carry-over rule for that product. Most practices have never had this list, which is why January feels like an ambush. Once every standing approval is on one sheet sorted by expiration, you can see exactly which patients are exposed and which are safe, and you can work the risk instead of reacting to rejections.
2. Sort Each Auth by Its Plan Carry-Over Rule
Not every approval expires the same way. Many Medicare Advantage and some employer plans reset at the plan year and require full reauthorization; others honor the approval for the approved course of treatment. The audit tags each active auth into the right bucket, so a standing infusion order under a plan that carries over does not get needless rework, and a GLP-1 approval under a plan that resets gets flagged for renewal now. Sorting by rule is what turns a wall of approvals into a short, prioritized renewal list.
3. Batch the December Renewals Before the Queues Flood
This is where the systems you already run, whether NextGen, Cerner, or AdvancedMD, let a specialist file renewals in batches straight from your panel. The reason December matters is timing: utilization management departments are flooded in the first week of January, so a renewal filed on January 2 lands in a backlog, while the same renewal filed in December clears with room to spare. Filing early also gives you a documented submission date and reference number, which is what supports a retroactive appeal if a plan drags an approval past the turnover.
4. Clear the January Backlog Before It Forms
Some renewals will still be in flight when the plan year turns, and a few plans will not accept a renewal until the new year opens. Those get worked the first business morning of January, in a single pass, before they become pharmacy rejections and canceled chair slots. The point is to attack the backlog as a known, finite list you built in November, not to discover it one denied claim at a time while patients are already at the counter.
5. Hand the Year-End Carry-Over to a Dedicated Outsourced Team
Practices that stop losing therapies on January 1 do it by handing the whole year-end carry-over to a dedicated outsourced team: the November audit, the December renewal batch, and the January backlog clear, live in 1 to 2 weeks. The re-authorization load that used to swallow two staff for three weeks comes off your in-office team, a trained backup covers every panel, and new-patient scheduling stops slipping while everyone chases renewals. Below is what it sounds like when nobody owns this yet, in practice teams’ own words.
Key Pain Points and Discussions by Providers
real reports from practice staff, lightly edited
“Every January we get ambushed. Approvals we won back in the fall just stop working, and we find out when the pharmacy rejects the claim or the patient calls asking why their medication was denied. Nobody ever gave us a list of which auths carry over and which do not, so we are always reacting instead of getting ahead of it.” – prior authorization lead, endocrinology group
“Two of my medical assistants did nothing but re-auths for three straight weeks after New Year’s. Sixty-plus renewals all landing at once, pump supplies and GLP-1s mostly, and meanwhile new-patient scheduling just slid. It is the same work we already did once, and we are paying to do it again on the worst week of the year.” – office manager, primary care practice
“The part that gets me is the timing. If we file a renewal on January second it sits in a backlog for weeks because every plan’s UM department is drowning. If we had filed the exact same thing in December it would have cleared clean. We know that, we just never have the bandwidth to get in front of it.” – practice administrator, multi-provider group
“We do not have one view of which patients are about to lose coverage. It lives in a dozen expiration dates scattered across the chart, in one person’s head, and on a sticky note. So a standing infusion order lapses, the chair sits empty, and we scramble a retro request that may or may not land.” – billing lead, specialty practice
“The insurance changes over the plan year and suddenly an approval that was rock solid in November is worthless. Same patient, same therapy, same medical necessity, but the calendar flipped and now it is our problem to prove all over again while the patient waits.” – revenue cycle manager, endocrinology practice
Our Answer
Here is what we actually do. Starting in November, a dedicated remote specialist pulls every active authorization on your panel and tags each one by its plan’s carry-over rule, then batches the renewals that will expire through December before the utilization management queues flood, then clears whatever is left in a single pass the first week of January. Our specialists are credentialed medical professionals trained in US prior authorization and payer-policy workflows, working inside your systems, with the AI handling the first pass on eligibility and document assembly and a human verifying every submission. The re-authorization load that used to swallow two of your staff for three weeks comes off your in-office team, and the new plan year opens with no patient sitting on an expired therapy. That model runs through our GLP-1 appeals and renewals workflow and every other therapy on your panel, in one paragraph.
Why This Keeps Happening
If a November audit and a December batch fix it, why does January keep ambushing fully-staffed practices? Because prior authorization is already the single most burdensome administrative task in a practice, and year-end simply concentrates it. The American Medical Association’s 2024 survey found physicians and their staff spend an average of roughly 12 hours per week on prior authorization, handling about 39 requests per physician per week. That load is heavy in an ordinary month. Pile a plan-year turnover on top of it, when a batch of standing approvals all reset at once, and the ordinary burden becomes a three-week crisis.
The deeper problem is that no practice has a single view of which authorizations carry over and which do not. Carry-over rules are set per plan and per product: many Medicare Advantage and some employer plans reset at the plan year and require full reauthorization, while others honor the approval for the approved course of treatment. Those rules do not live in one place. They live in a dozen expiration dates scattered across charts, in one experienced staffer’s memory, and nowhere at all for the plans nobody has hit yet. Without a consolidated list, the expired approvals cannot be worked ahead of time, so they surface as denied claims. This is exactly the gap a dedicated endocrinology prior authorization team is built to close.
And the timing multiplies the damage. Renewal requests do not clear at a steady rate all year; utilization management departments are flooded in the first week of January, so a renewal filed on January 2 lands in a backlog that can run for weeks, while the identical renewal filed in December clears with room to spare. Every day an approval sits expired is a day of pharmacy rejections, canceled infusion chairs, and patients calling to ask why their therapy stopped. The work was already done once in the fall. Doing it again in January, in the queue behind every other practice in the country, is the most expensive way to do it.
Most groups have already tried the obvious fixes before they talk to anyone. Each one fails the same way: the work lands back on the practice. The pattern, in one table:
| What you tried | What actually happened | Who ended up doing the work |
|---|---|---|
| Tracked expiration dates in the chart | Dates lived in a dozen places; the ones nobody happened to open lapsed silently | Whoever opened that chart next |
| Renewed reactively when claims rejected | Every renewal landed in the January UM backlog and ran for weeks while patients waited | The queue, badly |
| Leaned on one experienced staffer’s memory | It worked until she was out or the panel grew past what one head could hold | One person, until they left |
| Gave the year-end carry-over to a dedicated remote specialist | Every active auth audited in November, renewals batched in December, backlog cleared before it formed | Someone whose whole job it is |
The Solution
So what does “someone whose whole job it is” actually look like at year end? In November, the dedicated specialist pulls your full active-authorization panel and builds the list you never had: every standing approval, its expiration date, and its plan’s carry-over rule. That single audit is the whole game, because it converts a January ambush into a December to-do list you can see and work down. Nothing about your workflow changes except that the renewals stop being a surprise, which is the point of pairing the audit with Medicare prior authorization support for the plans most likely to reset.
Then comes the batch. Through December, the specialist files the renewals that will expire, in blocks straight from your panel, documenting the submission date and reference number on each one. That documentation matters twice: it clears the renewal before the January flood, and it gives you a paper trail to support a retroactive request if a plan drags an approval past the turnover. Your in-office team feels the change immediately, because the three-week re-auth scramble that used to start on January 2 simply does not happen. New-patient scheduling keeps moving because nobody is pulled off it to chase renewals.
Behind all of it, the AI takes the first pass and a credentialed human verifies. The automation assembles eligibility and prior-approval documents and flags expirations; the specialist confirms each renewal landed correctly and owns anything that needs a payer conversation. For plans that will not accept a renewal until the new year opens, the same team works the residual list the first business morning of January, and for approvals that slip through, the request routes into retroactive authorization support so a lapsed therapy still gets covered instead of written off.
Who Actually Does This Work
Fair question: why would an outsourced team manage your year-end carry-over better than your own experienced staff? Because the audit and the renewal batch are their whole job, and your staff’s whole job is the patients in the building. The people running your panel on our side are credentialed medical professionals: overseas-trained physicians, US-licensed nurses and pharmacists, and PharmDs, all trained specifically in US prior authorization and payer-policy workflows. They read carry-over rules for a living, so a Medicare Advantage reset and an employer-plan honor window are not a research project to them, they are a tag on a list. When sixty renewals have to move in a single month, the person moving them does that all day, across many panels, without new-patient scheduling collapsing behind them.
We are not a call center. We are a clinical operations partner, a healthcare BPO built on dedicated virtual staff: 500+ credentialed professionals, 24/7 coverage, and the AI first-pass plus human-verify workflow you just read about running behind every one of them. A typical practice is live in 1 to 2 weeks, at up to 70% below the cost of hiring locally. And because this all runs on patient and payer data, our HIPAA and security posture is independently auditable, with a trained backup already inside your workflow so a staffer being out never leaves a panel of expiring approvals unattended.
And the security piece your compliance officer will ask about: we are audited to SOC 2 Type II with zero exceptions and certified for HITRUST, ISO/IEC 27001:2022, HIPAA, and GDPR, with zero breaches in eight years. Every workstation runs inside a secure enclave on US-based servers, with screen captures and downloads blocked by policy, so PHI never sits on someone’s home laptop. Every client account carries a $5M E&O and cyber liability policy and a BAA signed before any work starts; the full detail lives in our HIPAA and security posture.
Put the routine and the people together, and a specific list of things simply stops happening.
Ready to Fix Your Year-End Auth Problem?
How We Permanently Fix the Process
A one-time cleanup is not the fix, and neither is a better spreadsheet. The fix is a standing November audit, a December renewal batch, and a documented carry-over map that says exactly which plans reset and which honor an approval, for every product on your panel. Before we run a single renewal for a new practice, we build that map against your actual payer mix, so the audit is not guessing at rules, it is applying the ones your patients’ plans actually use, tagged patient by patient with an expiration date attached.
From there the carry-over map becomes a living playbook rather than a fact locked in one person’s head. It records which plan products reset at the plan year, which honor the approved course of treatment, how each renewal should be documented, and the exact escalation path when a plan drags an approval past the turnover. It is written down, kept current, and owned by the team, so the audit repeats itself every fall without anyone rebuilding it from scratch.
That is the difference between surviving this January and fixing the process for good, and it is what a dedicated prior authorization partner actually buys you. A staffer leaving used to mean the carry-over knowledge walked out the door and the next January fell apart. Under this model the map stays, the backup runs the same audit, and the plan year turns over without a single patient losing a therapy they were already approved for.
The Whole Thing in Four Sentences
Standing prior authorizations vanish on January 1 because carry-over rules differ by plan, and many Medicare Advantage and some employer plans invalidate approvals at the plan year, while practices have no consolidated view of which patients fall in which bucket. Tracking dates in the chart, renewing reactively, and leaning on one staffer’s memory all fail the same way, by surfacing the expired approvals as denials instead of renewals. The fix is a November audit that tags every active auth by its carry-over rule, a December renewal batch filed before the utilization management queues flood, and a January backlog cleared before it forms. An endocrinology group runs exactly this model with us today, names withheld, no patient data shown.
If you want to check us out before talking to anyone: our security posture is independently auditable, we are an MGMA 2026 Corporate Member, and 800+ providers run back office work with us.
Ready to fix your year-end auth problem? Try us risk free: two weeks, your real active-authorization panel, a November-style audit and a renewal batch run before the plan year turns, and if it does not earn the handoff, you walk away. From here down is the sales part, and it is short: here is exactly what it costs.
One Flat Weekly Rate. 45 Hours of Coverage.
No hourly meters, no setup fees, no long-term contracts. Your dedicated team member covers your desk 45 hours every week, and a trained backup steps in at no charge whenever they are out.
One dedicated remote prior authorization specialist running your November panel audit and December renewal batch, single-specialty practice with a defined active-auth panel
5+ remote specialists tagging and renewing standing authorizations across a multi-provider group or several sites before the plan year turns
10+ remote specialists, multi-location group, MSO, or PE-backed platform clearing year-end auth carry-over across many panels at once
45 hours of coverage for less than others charge for 40.
Standard US full-time year: 40 hrs x 52 weeks = 2,080 hours, the federal basis for computing hourly pay per the U.S. Office of Personnel Management. A Staffingly plan: 45 hrs x 52 weeks = 2,340 hours a year, that is 260 additional hours included in your flat rate. $399/week x 52 = $20,748 a year / 2,340 hours = $8.87 per hour. Typical US market rates for healthcare virtual assistants run $9.50 to $13.00 per hour for 40 hours of coverage.
Start the New Plan Year With Zero At-Risk Therapies
You have seen the whole method. The pilot proves it on your own active-auth panel, with a carry-over tracker your team can watch every day.
Book a 2-Week Risk-Free PilotRequest Information
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Frequently Asked Questions
Where the Claims on This Page Come From
Sources & References
- AMA 2024 Prior Authorization Physician Survey. Reports that physicians and staff spend an average of roughly 12 hours per week on prior authorization and handle about 39 requests per physician per week. ama-assn.org
- CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). Federal rule governing prior authorization processes, timeliness, and payer transparency for Medicare Advantage, Medicaid, CHIP, and Exchange plans. cms.gov
- MGMA Practice Operations and Revenue Cycle Resources. Prior authorization, denial, and administrative-burden benchmarks for medical group practices. mgma.com
- HFMA Revenue Cycle Guidance. Provider-side guidance on authorization tracking, expired-authorization denials, and year-end renewal workflow. hfma.org
- Physicians Practice Front-Office and RCM Operations. Practice-management guidance on prior authorization renewal, expiration tracking, and the revenue tied to timely authorizations. physicianspractice.com
