Why Are We Still Faxing Prior Authorizations in the ePA Era?

What Gets Every Authorization Through the Fastest Valid Channel

The goal is that no request goes by fax when a portal would clear it faster, and every fax that must go leaves a delivery trail. Here is what does that, move by move.

1. Audit a Month of Submissions by Channel

Before changing anything, pull a month of prior authorizations and tag each one by how it went out: portal, electronic, or fax. Most practices are surprised by the result, because a large share of requests go by fax even when the payer accepts them electronically. Industry data has found roughly half of prior authorizations still go out by phone or fax despite electronic options being widely available. You cannot fix a channel problem you have not measured, and the audit almost always shows dozens of fax requests that never needed to be.

2. Build a Submission-Channel Matrix per Payer and Service Line

The core fix is a written matrix: for each payer and each service line, what is the fastest valid channel? Some payers take everything electronically. Some take imaging authorizations by portal but drug requests by fax. Some are fax-only for a specific service. Right now that knowledge lives in one veteran staffer’s head, which is why the office defaults to fax when they are out. Writing it down turns the channel choice from a guess into a lookup, and the fastest path becomes the default instead of the exception.

3. Route Every Request Through the Fastest Valid Path

With the matrix in hand, every request goes out the fastest way that payer and service line will accept, and this is where the systems you already run, whether NextGen, Cerner, or AdvancedMD, let a specialist submit electronically where the payer supports it and log the channel and timestamp against the record. No more faxing a request to a payer that would have cleared it through a portal in a fraction of the time. The default stops being what the office has always done and becomes what actually moves fastest for this specific payer.

4. Convert Fax-Only Requests to Tracked Digital Fax

Some requests genuinely have to go by fax, and for those the fix is proof of delivery. Instead of a machine fax that succeeds or fails silently, the specialist uses tracked digital fax with delivery confirmation, so there is a timestamped record the payer received it. That closes the most common fax failure, the request the payer swears never arrived, and it means a fax-only payer no longer has a plausible way to lose a request without a trail. Every submission, electronic or fax, leaves evidence it landed.

5. Hand Submission Routing to a Dedicated Outsourced Team

Practices that stop over-faxing do it by handing submission routing to a dedicated outsourced team: credentialed remote specialists who keep the channel matrix current, route every request the fastest valid way, and confirm delivery on every fax, live in 1 to 2 weeks. Average submission-to-decision time drops measurably once nothing goes by the slow path out of habit, and the channel decision stops depending on which staffer is in that day. Below is what it sounds like when nobody owns this yet, in practice teams’ own words.

Why This Keeps Happening

If electronic prior authorization exists, why is half of it still going out by fax? Because ePA adoption is partial and uneven, not universal. A payer may take imaging authorizations through a portal but require drug requests by fax; another may support electronic submission for some codes and not others; a third may be fax-only for a specific service line. Industry data has found that roughly half of prior authorizations still go out by phone or fax despite electronic options being widely available. There is no single button that just does the right thing, so the office falls back on the one channel that always works, which is fax.

And the reason fax wins by default is that the routing knowledge lives nowhere durable. One veteran staffer knows which payer takes what channel, and everyone else defaults to fax when that person is out, because fax is the move that never gets a request rejected for wrong channel. That is a rational choice for an individual staffer under time pressure and a costly one for the practice, because it trades a few seconds of certainty for a couple of days of turnaround on every request. This is exactly the gap a documented payer-specific prior authorization matrix is built to close, by turning tribal knowledge into a written rule anyone can follow.

The cost compounds quietly. A practice completes a large volume of prior authorizations every week, and industry estimates put the average at around 13 hours of staff time weekly across roughly 40 requests. Every request that takes the slow channel out of habit adds days a portal would not have, and a full shift to electronic submission has been estimated to save the industry hundreds of millions of dollars a year in avoided phone and fax work. At a single practice, that shows up as faster starts, fewer follow-up calls, and staff hours returned, which is why owning the whole electronic prior authorization routing decision pays for itself.

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:

The Solution

So what does disciplined channel routing actually look like on a Tuesday morning stack of authorizations? The specialist works the matrix, not their memory. This payer takes this service line electronically, so it goes through the portal and the timestamp lands in the record. This one is fax-only for drug requests, so it goes by tracked digital fax with a delivery confirmation attached to the chart. Nothing gets faxed because faxing is the habit; every request takes the fastest path that specific payer and service line will accept. That is the whole point of pairing a written matrix with an owner who actually runs electronic prior authorization the disciplined way.

Then comes the part the fax-everything default never had: proof on every submission. The electronic requests carry a portal timestamp; the fax-only ones carry a delivery confirmation. So when a payer says it never received a request, there is a dated record showing it did, and the request does not restart from zero. Your staff feel the change inside the first week, because the follow-up calls to confirm a fax landed, and the re-submissions when it did not, simply drop. The channel is right the first time, and there is evidence it arrived.

Behind all of it, AI flags which channel a payer accepts for a given service line and a credentialed human verifies and submits. The system surfaces the fastest valid path; the specialist confirms it is current for that payer and sends it. For the requests that come back needing an override before they can proceed, the same owner carries them straight into a step therapy override request without losing the submission history already logged.

Who Actually Does This Work

Fair question: why would an outsourced team route your submissions better than the staff who send them every day? Because their whole job is the routing rule, and your staff’s job is everything else in the office at once. The people working these cases 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 multi-payer submission workflows. They keep the channel matrix current across many payers and many practices, so they know which plan changed its portal last month and which service line went fax-only, instead of defaulting to fax because it is safe. Keeping that matrix accurate and routing against it is the entire job.

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 an AI-flags-then-human-verifies workflow 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 every submission moves protected patient data through payer portals and digital fax, we run every request inside our HIPAA and security posture, which you can read about in our HIPAA and security posture. Nobody on our side goes dark without a trained backup already inside your workflow, so the fastest-channel discipline never depends on one person being in.

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.

How We Permanently Fix the Process

A rule of thumb is not the fix, and neither is one person who knows the channels. The permanent fix is a documented submission-channel matrix that says, for every payer and service line you touch, exactly which channel is fastest and valid, so the routing does not live in anyone’s memory. Before we route a single request for a new practice, we audit a month of your submissions to see how much is going by fax that did not need to, and we build the matrix against your actual payer mix, not a generic list. The audit itself usually surfaces the days you have been quietly giving away.

From there the channel matrix becomes a living playbook rather than a habit. It records which payers take which service lines electronically, which are fax-only, how each portal behaves, and the exact fallback when a portal is down. It is written down, kept current as payers change their rules, and owned by the team. When your specialist is out, a trained backup works the same matrix the same way, so nothing reverts to fax-everything just because one person is off that day.

That is the difference between shaving days off this month’s requests 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 channel knowledge left with them and the office defaulted back to the slow path. Under this model the matrix stays, the discipline stays, the backup steps in, and the fastest valid channel stays the default no matter who is at the desk.

The Whole Thing in Four Sentences

Practices still fax in the ePA era because electronic adoption is partial and payer-specific, and the knowledge of which channel is fastest for which payer lives only in staff memory, so defaulting to fax feels safest. Telling staff to use portals, relying on one veteran biller, or keeping fax as the universal fallback all fail the same way, by leaving the channel choice to memory and habit. The fix is a documented submission-channel matrix per payer and service line, every request routed the fastest valid way, and every remaining fax sent by tracked digital fax with delivery confirmation. A multi-specialty 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 stop over-faxing? Try us risk free: two weeks, your real request volume, one dedicated specialist routing every authorization the fastest valid way, 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.

Written By

Dan Nandan

CEO, Staffingly, Inc.

Dan Nandan has spent 25+ years in IT consulting and healthcare BPO, was among the first in the US to build an RPO/BPO delivery network in India, and has been featured in Computerworld. He runs the operations and the dedicated virtual teams behind the workflows on this page; the team-voice answers above come from the remote specialists who work them every day.

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