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Electronic Prior Authorization Toolkit

Faster payer responses, smoother transactions, better service

Prior authorization transactions can be slow and tedious. Your practice’s time is better spent providing attentive medical care and responsive customer service. Handling your prior authorizations electronically can:

  • Speed up health insurer response
  • Minimize time and resources devoted to manual processes, such as waiting on hold and compiling faxes to payers
  • Free up time for revenue-enhancing functions such as ensuring correct payment
  • Reduce transaction costs by over 80%

Cost of conducting manual prior authorizations: $10.78 x 200 = $2,156
Cost of conducting electronic prior authorizations: $2.07 x 200 = $414

Average annual savings per physician from automating prior authorization: $1,742*

* Based on an annual average of 200 prior authorizations submitted for a single physician. Source: Milliman, Inc., “Electronic Transaction Savings Opportunities for Physician Practices.” Technology and Operations Solutions. Revised: Jan. 2006

View archived informational webinar
Evaluating your practice’s situation

Considerations for processing electronic transactions in the physician practice” offers specific scenarios of how your practice might adopt electronic transactions, and provides additional considerations for your specific situation.

Questions to ask before enrolling in an electronic health care transactions program

Access health insurer online resources

Visit www.ama-assn.org/go/payerpolicies to access online resources from health insurers to help you move towards practice automation.

Case study: How much can you save?

The suite of electronic health care transactions are designed to work together to create greater efficiencies for both physicians and health insurers. By adopting an integrated approach to using the electronic health care transactions, information gained from one transaction becomes useful information in the next transaction.

  • Did you know that the increased use of electronic health care transactions in your practice, such as the electronic eligibility benefit inquiry and response transactions, has the potential to save physicians and health insurers nearly $30 billion per year? [1]

Access this case study to learn more about the savings your practice can experience using electronic health care transactions.


[1] U.S. Healthcare Efficiency Index, www.ushealthcareindex.com .

AMA advocates for automation of prior authorization

Because of the significant savings of time and revenue that can be achieved by physicians through automation of the claims process, the AMA diligently advocates for continued administrative simplification. Today, the prior authorization process is all to often manual, time-intensive and confusing for all stakeholders. The AMA believes that the best automated solution for prior authorization would be a single, standard electronic PA process applicable to all service types that include medical, pharmacy, laboratory, radiology and durable medical equipment (DME) services to reduce the administrative burden placed on payers and physicians alike. Read the AMA's workflow recommendation.

Access the "Standardization of prior authorization process for medical services” white paper for more information on AMA’s efforts to push for a standard and streamlined automated prior authorization process to reduce those unwanted administrative hassles and hoops to obtain approval to do you’re your practice does best, provide quality care for a patient.