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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

Prior Authorization Advocacy

The National Committee on Vital and Health Statistics (NCVHS) is the federal agency with responsibility for the electronic health care transaction standards and other administrative simplification provisions contained within the Patient Protection and Affordable Care Act. AMA has provided the following testimony to NCVHS regarding the prior authorization process

June 16-17, 2015

February 26, 2015

  • Joint presentation testimony of American Hospital Association, Medical Group Management Association, and AMA regarding operating rules for prior authorization.

February 19, 2014

Archived Informational Webinar