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
“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 a health insurer before enrolling in an electronic transactions program” outlines key issues with using electronic transactions that you need to carefully consider.
- “Questions to ask a billing service before enrolling in an electronic transactions program” provides key questions to discuss with your billing service to understand how it can assist you in using electronic transactions.
- “Questions to ask a clearinghouse before enrolling in an electronic transactions program” provides key questions to discuss whether your clearinghouse provides satisfactory functionality for electronic transactions.
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? 
Access this case study to learn more about the savings your practice can experience using electronic health care transactions.
 U.S. Healthcare Efficiency Index, www.ushealthcareindex.com .