Prior Authorization Playbook: Reduce Turnaround Time Without Denial Spikes

Strategies to Streamline Workflow and Protect Revenue

Prior authorizations are one of the most time-consuming and error-prone tasks in medical billing. Delays lead to appointment rescheduling, patient frustration, and lost revenue. But rushing the process can trigger denials, compliance risks, or retroactive recoupments.

At ACCORDPRO, we help healthcare practices build efficient, accurate prior authorization systems that reduce turnaround time—without increasing denials.

Here’s your playbook to take control of the prior auth process in 2025.

1. Standardize When and What Needs Authorization

Many denials happen before the claim is even submitted—because no one realized an authorization was required.

What to Do:

• Build a payer-specific auth matrix for your top CPT/HCPCS codes

• Include rules by payer, plan type, and service category (imaging, injections, DME, etc.)

• Train front-desk and scheduling teams to check auth requirements at the time of booking

2. Verify Eligibility Before You Submit the Auth

Submitting an auth for an inactive plan—or for a service not covered—wastes days.

What to Do:

• Verify active coverage and plan type before starting the auth

• Use payer portals or automated tools like Availity or Change Healthcare to confirm benefits

• Document the eligibility check for audit protection

3. Pre-Build Auth Templates for Common Services

If you're doing prior auths for the same procedures weekly, automate the process.

What to Do:

• Create pre-filled prior authorization templates with standard documentation

• Include diagnosis codes, supporting notes, and ordering provider info

• Use macros or digital forms to speed up submission without sacrificing quality

4. Track Auth Requests in Real Time

The biggest delays happen when auth requests are submitted—but never followed up.

What to Do:

• Implement an auth tracker or dashboard with key statuses: pending, approved, denied, expired

• Assign follow-up responsibility to a specific team member

• Follow up at 48-hour intervals until response is received

5. Avoid Denials by Attaching the Right Clinical Support

Generic chart notes won’t cut it—especially for high-cost imaging, infusions, or procedures.

What to Do:

• Use checklists for clinical documentation by procedure type

• Include conservative care history, previous test results, and medical necessity notes

• Anticipate common payer objections and respond in advance

6. Confirm the Auth Before the Patient Arrives

Nothing hurts patient trust more than getting canceled the day of the procedure due to a missing auth.

What to Do:

• Confirm the auth ID and expiration date at least 24–48 hours prior

• Reconfirm eligibility and any secondary payer coordination

• Log approvals into your EHR or billing software for audit readiness

7. Measure Auth-Related Denials—and Fix the Source

Denials related to prior auth should be tracked separately so you can pinpoint breakdowns.

What to Do:

• Categorize denials by no auth, expired auth, incorrect plan, insufficient documentation

• Review monthly trends by service and staff member

• Fix process gaps and retrain where needed

How ACCORDPRO Can Help

We help practices reduce prior authorization turnaround time and decrease denials by:

• Building custom payer requirement databases

• Automating eligibility + benefits verification

• Standardizing documentation workflows

• Creating digital tracking tools and follow-up systems

• Offering denial trend analysis and appeals support

Our credentialed billing team integrates seamlessly with your front desk, clinical staff, and payers to keep authorizations moving without dropped balls or reimbursement risk.

Final Thoughts

Prior authorization doesn’t have to derail your schedule or your revenue. With the right playbook, you can get faster approvals, reduce cancellations, and protect your bottom line—without spikes in denials.

Need help building a bulletproof prior auth workflow?

 📞 Contact ACCORDPRO at 425-215-0517 or visit www.accordpros.com to schedule a workflow audit or automation demo.