Managing prior authorizations can be one of the most frustrating parts of running a healthcare practice. The process often involves lengthy phone calls, detailed paperwork, and frequent follow-ups with insurance companies. If not handled correctly, it can delay patient care, increase denials, and strain your staff.
By improving your prior authorization management, you can reduce errors, speed up approvals, and ensure patients get the care they need. Here are eight practical tips to help you manage prior authorizations more effectively.
8 Tips for Effective Prior Authorization Management
1. Designate a Dedicated Team Member
Assigning prior authorizations to a specific person helps ensure that nothing gets missed. It creates consistency in how requests are handled and improves accuracy. If your team is stretched too thin, outsourcing is a great option.
2. Keep a Checklist for Each Insurance Provider
Each insurance company has its own rules. Using payer-specific checklists ensures that correct information is gathered from the start. This is true whether the task is handled in-house or by an outsourcing partner. A checklist for each payer helps your team collect the correct information the first time. This reduces back-and-forth and lowers the risk of denials.
3. Verify Insurance Benefits Before the Request
Make sure a service is covered before starting the authorization process. Verifying coverage early can prevent surprises and avoid wasted time on services that don’t qualify. This step matters, whether your team manages authorizations in-house or with a partner. Confirming eligibility at the start helps reduce denials. And it supports a smoother process for patients and staff alike.
4. Use Standard Templates and Forms
Creating templates for common procedures can help your team—or your outsourced support—work faster and more accurately. Having a list of required documents and sample language for clinical justifications can save time.
5. Track Every Request
Keep a record of all authorization requests, including submission dates, documents sent, and responses received. This step is just as important when working with an external partner to maintain visibility and ensure timely follow-ups. A simple tracking system helps you follow up on pending approvals and catch delays early.
6. Follow Up Promptly
Don’t wait for insurance companies to respond. Following up promptly helps push requests through and avoids unnecessary delays.
7. Train Staff Regularly
Insurance rules change often. If you manage prior authorizations in-house, your team must stay updated. If you outsource, make sure your partner provides ongoing training to their staff and stays current on payer updates. Make sure your team stays updated with payer policies and system updates. A well-trained team will make fewer errors and move requests through faster.
8. Choose to Outsource
If prior authorizations are slowing down your practice, it’s time to outsource this task to professionals who specialize in it. A reliable service can manage submissions, follow-ups, and appeals from start to finish. This speeds up approvals and improves accuracy, and lets your staff focus on providing care—not paperwork.
Smarter Prior Authorization Management
Prior authorizations are a necessary part of healthcare, but they don’t have to be a burden. You can make the process more manageable with the right systems, training, and support.
Oclinicals provides professional prior authorization management services. We’ll help reduce errors, speed up approvals, and ease the strain on your team. Our trained associates handle the work so you can focus on your patients.
Contact us today to learn how we can support your practice with prior authorization management.