Pain to Promise:
Prior Authorization Automation That Works for Providers

Prior authorization exists at the intersection of cost management and care oversight, but it has become one of the most disruptive processes in healthcare. Fragmented requirements, inconsistent payer rules, and manual workflows are creating widespread inefficiencies across the revenue cycle, affecting financial performance, staff productivity, and patient/resident access to care.

Survey findings from more than 370 revenue cycle leaders highlight the scale of the issue. Prior authorization is reported as a top or significant challenge by 56% of healthcare revenue cycle leaders, with the impact even more pronounced in hospitals and health systems where 85% of revenue cycle leaders cite it as a major concern. At the executive level, 70% of leaders across all care settings now view prior authorization as a critical issue, underscoring its impact on both operations and financial stability.

Despite its importance, the process remains heavily manual. Organizations continue to rely on payer portals, phone calls, and fax, with 93% using at least one of these methods and only 28% reporting any use of automation. Manual prior authorization workflows have compounded the administrative burden as 66% of providers manage prior authorizations locally, and 56% of revenue cycle leaders cite the variability in payer requirements as a key challenge.

These challenges drive measurable consequences, including financial loss, increased administrative costs, and delays in patient or resident care. As regulatory changes and industry momentum push toward standardization, electronic prior authorization (ePA) offers a path forward.

This white paper examines the current state of prior authorization, the challenges providers face across care settings, and the opportunity to transition to a more efficient, automated approach.