Prior authorization is needed by many insurance plans before certain medical procedures, medicines, or imaging tests can be approved. While it helps control health costs and stops unnecessary treatments, the current system often causes delays and extra work.
Healthcare providers in the United States spend a lot of time handling these authorizations by hand. According to surveys by the American Medical Association (AMA), providers spend about 13 hours each week working on around 39 prior authorization requests. This includes filling forms, sending documents, making phone calls, checking status, and dealing with denials or appeals.
The extra paperwork leads to staff burnout and higher costs. Nearly 90% of medical practices say prior authorizations are “very” or “extremely” hard to manage (MGMA, 2023). To manage this, 92% of practices have hired more staff just for authorization tasks — which increases expenses but does not fully fix the problems.
Delays caused by these manual processes also affect patient care. Up to 90% of doctors say they have seen bad effects on patients because of authorization delays. One-third have seen serious medical problems linked to slow approvals (AMA). About 80% of doctors have noticed patients stop their treatments because it takes too long or is too hard to get prior authorizations.
These delays make it harder to diagnose and treat quickly, especially in areas like radiology where imaging tests often need approval first. Doctors feel frustrated by the heavy paperwork and complicated insurance rules, which makes healthcare harder to deliver.
Electronic prior authorization (ePA) systems make the process easier by putting authorization steps right inside the provider’s Electronic Health Record (EHR) system. Instead of using separate websites, faxing forms, or making calls, clinicians can start and finish prior authorizations inside the EHR they already use.
There are several benefits for medical practices with this integration:
Several rules and policies encourage medical practices to use electronic prior authorization systems that work inside EHRs:
Artificial intelligence (AI) and automation help improve electronic prior authorization. These tools reduce manual steps, raise accuracy, and speed up approvals.
Tools like ImagingAssure use AI to give clinical decision support inside EHR workflows. They check medical necessity and insurance rules automatically when an order is made. Instead of waiting for payer reviews after submission, providers get guidance right away about what documents are needed. This helps prevent denials caused by missing or wrong info from the start.
Dr. Hamed Abbaszadegan from Stanson Health says that CDS software “finds objective data in patients’ charts to complete prior authorizations automatically.” This lets doctors spend more time with patients and less on paperwork.
AI systems use dynamic queues to sort authorization requests by urgency and difficulty. Automated routing sends clinical documents, follow-ups, and renewal alerts to the right staff members. This cuts down repeated work and errors from manual tracking. The clear workflow boosts consistency and speed.
Insurance rules change often, and outdated info can cause denials or appeals. Automated systems keep real-time updated knowledge bases that guide providers through current payer rules. This means staff do not have to spend time researching confusing policies. Up-to-date info lowers mistakes and raises approval rates the first time.
AI also helps link prior authorization tools smoothly with EHRs and billing systems. This lowers repeated data entry and supports the entire billing process by cutting claim denials and helping faster payments. For example, Experian Health’s Authorizations platform includes automatic inquiries, image storage, reconciliation tools, and sending authorization data back to clinical and admin systems. This improves overall workflow.
By automating many repetitive tasks, AI-driven prior authorization tools help reduce staff shortages and burnout. About 37% of U.S. providers report burnout in recent surveys. Automation lets staff spend more time doing clinical work and talking with patients instead of dealing with complex paperwork.
For medical administrators and IT leaders in U.S. healthcare, adding electronic prior authorization systems inside EHRs is an important choice. Success depends on several points:
By carefully adding electronic prior authorization into their EHR systems, U.S. medical practices can handle paperwork better, reduce workflow problems, and get patients the care they need faster.
Electronic prior authorization is no longer something in the future. It is a practical tool helping healthcare providers today. As the U.S. adopts more health IT solutions and new rules demand more transparency, putting ePA systems inside existing EHRs is important for cutting inefficiencies and improving patient care across the country.
Yes. Electronic Prior Authorization is most efficient for prospective workflows that allow initiation and approval prior to pharmacy involvement. It can also handle retrospective prior authorizations triggered by pharmacies, enabling completion or continuation of requests electronically.
By integrating prior authorization within the EHR workflow and using dynamic question sets, Electronic Prior Authorization decreases median time to decision by 69% compared to manual processes, saving over two days in wait time and accelerating medication access and therapy initiation.
Question sets are customized, drug- and plan-specific electronic forms presented within the EHR. They replace static paper or PDF forms by only asking relevant clinical and demographic questions needed for the medication, pre-filling patient info, thus speeding submission and minimizing administrative burden.
It is embedded within the provider’s EHR system, allowing initiation, question answering, and receipt of determinations within a single workflow. This seamless integration reduces workflow disruptions and enables staff to manage requests efficiently without external systems.
Yes. Providers can use the Surescripts Prior Authorization Portal, a free, fully electronic platform that connects to pharmacy benefit managers, enabling electronic submission, tracking, and management of prior authorizations even without EHR integration.
Automation creates routing rules to delegate tasks such as submitting clinical info and managing follow-ups, reducing prescriber workload. Reports indicate up to a 45-minute time saving per authorization and significantly reduced staff overtime, increasing operational efficiency.
Prior authorization indicators are sent directly from PBMs or health plans, reflecting real-time benefit plan designs. This integration, paired with On-Demand Formulary and Real-Time Prescription Benefit inquiries, ensures prescribers get accurate, updated notifications about authorization needs.
By speeding approval so prescriptions are authorized before patients arrive at pharmacies, it reduces delays and enhances adherence. One health system increased pickup rates by six percentage points after implementing the solution, improving overall medication access.
Surescripts sends proactive alerts to providers when prior authorizations are nearing expiration, prompting timely renewals. This helps avoid therapy interruptions and supports continuous patient care without manual tracking.
Adoption is rapidly increasing. In 2022, there was a 44% rise in electronic prior authorizations processed, and 84% of prescribers now use EHRs equipped with Electronic Prior Authorization, demonstrating growing acceptance and integration into healthcare workflows.
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