Thirteen hours a week on prior authorizations. Which part does an agent take?

Ask anyone who runs the front office of a clinic what eats the week, and prior authorization comes up before you finish the question.

The numbers agree. In a late 2024 survey of 1,000 physicians, the American Medical Association found that practices handle an average of 39 prior authorization requests per physician per week, and that physicians and their staff together spend an average of 13 hours a week on them. Forty percent of the physicians surveyed have staff who work on nothing else.

What those hours are made of

Prior authorization is not one task. It is a chain of smaller ones, and many links in that chain are repetitive administrative steps.

1. Noticing that an order needs authorization. Someone checks the insurer's rules, or finds out when a claim comes back.
2. Gathering what the insurer wants: diagnosis codes, the order, recent notes, sometimes treatment history. Some of it is in one place in the chart; some is spread across visits or needs a clarifying question to the provider.
3. Entering it into the insurer's portal or form, field by field, often the same fields the chart already holds.
4. Submitting, then checking back. Log in, look up the status, log out. Again tomorrow.
5. Recording the outcome in the chart and telling the patient and the scheduler.
6. If your team decides to appeal, gathering the supporting material and making the clinical case.

Some of those steps need a clinician's judgement or a conversation. Many of them are the same reading and typing, repeated for every request.

Where the industry is heading

The insurer side is moving, slowly. The 2024 CAQH Index, the yearly measure of how much of healthcare's administrative work is done electronically, reported that medical prior authorization volume fell 3 percent in the year it measured. It also noted that one large national plan removed nearly a quarter of medical services from its prior authorization requirements in 2023. Across all the medical and dental administrative transactions it studies, not prior authorization alone, the Index estimates an industry savings opportunity of about 20 billion dollars a year if the remaining manual and partly electronic transactions moved to fully electronic processing.

In the Index, portals remained the most common way providers requested prior authorization, and the AMA survey describes what the weeks looked like in late 2024.

What an agent takes, and what it does not

An agent, in the sense we build them, is software that signs into the systems your team already uses, with its own login, and does one repetitive job inside them by following rules your team wrote down with us.

The agent watches the list of orders awaiting review and flags anything that needs authorization under the insurer rules you give it. It gathers the records you specify from the chart: the codes, the order, the notes. It enters them into the insurer's portal one field at a time and checks each field against the source before it moves to the next. It checks status on a schedule and records the result in the chart. When a denial comes in, it gathers the records an appeal would need, so a person starts with those ready for review instead of a blank page.

Your team keeps the decisions. The agent prepares the request; your team reviews it, and the clinical information behind it, before it is submitted. If an insurer asks for something the rules do not cover, the agent stops and hands that case to a person with everything it gathered so far. The appeal argument is a human job, and so is the conversation with the patient.

Nothing is submitted to an insurer without that review, and each run records what the agent read, entered, and handed off.

What changes for the person at the desk

Instead of starting the day with a list of portals to log into, the person starts with a short list of cases that need a decision: these are ready to send, these two came back denied, this one the insurer wants more on. The repeated entry, the status checks and the file gathering are done before they sit down; the review, the exceptions and the appeals are what remain.

That is a fair description of what we build: not an end to prior authorization, which no one can promise. The agent handles the repeated chart to portal entry, so your team can focus on review and exceptions.

What we need from you to build it

Three things, all of which your team already has in some form. The insurer's requirement list for the order type, as your staff actually apply it, including the exceptions they have learned by hand. A handful of real past requests, with the identifying details removed, so the rules can be written against real cases rather than a description. And a name: the person who signs off before a request goes, and who receives the cases the agent hands back.

Where we would start

With one insurer and one order type, the combination that generates the most requests for you with the most predictable requirements. We write the rules down with your team, decide together when your team reviews the work, and run the agent alongside your current process until your team is satisfied with how it performs. Then the next insurer.

If prior authorization is the task eating your week, tell us about it. We will look at one workflow with you and say plainly whether it is a fit.

Tell us the task

This article is general information about administrative work in clinics. It is not medical, legal or billing advice.