Beginner’s Guide: How To Streamline Prior Authorization In 2025?

Streamlining the prior authorization process could be a game-changing factor in healthcare 2025 which ultimately transforms the overall patient outcomes.  Based on the survey conducted by American Medical Association with 1000 physicians, nearly 64% of physicians reported they face long wait times (one business day) for payers to decide on prior authorization which negatively impacts the patient outcomes.

So understanding the prior authorization process can help healthcare practices to improve compliance and increase approvals. Researching among health practices and physicians about the factor impacting patient care – prior authorization stands first on the list. Yes, the complexities involved in the authorization process such as approvals for every service like device, pre-op and post-op visits, tests, and more will take an extensive amount of the care provider’s time and efforts.

Heading into healthcare 2025, the prior authorization need not be complicated and could be easily simplified with effective strategies. In this blog, we discussed how to streamline the prior authorization process smartly.

5 Best Ways To Streamline Prior Authorization Process

1. Gold Card System

This is a process under which a payer excludes doctors who reliably order or prescribe medicines and medications as per evidence-based guidelines, or have high approval rates from PA requirements. So in case you’re not an exception doctor—if your PA demands are affirmed as expected—at, suppose, a 90% rate—at that point payers feel glad to grant you that proverbial gold card, permitting you to get your patients quick access to the care towards which they have been paying their expenses.

2. Transparent Communication System

Good and clear communication between healthcare providers and payers on the services that need prior authorization would help to streamline the overall PA process. To makes this process easy, the Centers for Medicare & Medicaid Services (CMS) has announced an initiative program that allows healthcare providers to directly interact with the payer‘s platform through a secure system.

The objective of this program is to instantly identify whether a specific treatment, relevant documents or medication process needs prior authorization or not.

3. Insurer’s Authorization Is Also Important

A problem usually arises when a patient changes their health insurance provider. Due to the change, a whole new process and repeated protocols are important before starting with the treatment. This could seriously impact the patient’s health. Additionally, shifting to the new payer should also leave extra treatment costs for physicians.

The only solution is to accept the previous insurer’s prior authorization. Establishing a streamlined process to do so will help you to deliver quality care to your patients on time while also reducing unnecessary treatment costs.

RELATED: 5 TIPS TO HANDLE PRIOR AUTHORIZATION IN RCM

4. Speed Up The Prior Authorization Process

The usage of manual methods for the pre-authorization process will slow down the process and impact patient outcomes. So speeding up the PA process will help you to drive better results, but how to speed up things easily? Some of the key tactics to speed up the prior authorization process includes,

• Hire a prior authorization expert
• Embrace advanced technology like electronic prior authorization software or medical billing software with emerging PA features.
• Sign up for payer’s newsletters
• Keep authorizations in a central location
• Regularly document clinical data
• Create a follow-up plan for successful PA process
• Educate your patients about prior authorization by offering special training sessions.

5. Automation Of Prior Authorization

It is impossible for any practice to manually review the prior authorization of every paper.  Automation is one of the best strategies to streamline the PA process by quickly identifying accurate medications or treatments. Adopting automation solutions like electronic PA would drastically eliminate time-consuming manual processes and maximize revenue.

• Automates prior authorization tasks
• Reduces both physician and administration burden
• Provides real-time data about patient payment
• More accurate claims
• Reduced denial rates
• Increased practice productivity

Final Thoughts

Follow these strategies to streamline your prior authorization process in 2021 which also leads to higher revenue and streamlined patient care. Looking for the best prior authorization services for your practice? CapMinds are here to minimizes the hassles of dealing with insurance companies

How CapMinds Prior Authorization Services Helps You?

• Save time and money spent on the phone waiting, completing forms, and submitting paperwork
• Reduce reschedules and delays in the care given by receiving timely approvals from payers
• Manage and review multiple orders with 24/7 access to a secured, online dashboard
• Easily track the status of all your submissions through the online portal
• Avoid delivering costly services resulting in denials or incomplete or no reimbursement.