09/03/2026
Prior authorization is usually treated as a staffing problem. Add another person to the queue, work the phones, chase the fax.
A lot of it is a contract problem.
Turnaround expectations, which services require authorization at all, appeal timelines, and how retro authorizations are handled are terms that live in your payor agreements. When those terms are vague or absent, the payor's default policy fills the gap, and your staff absorbs the difference in hours.
Things worth reviewing in your current agreements:
• Whether the contract specifies response timeframes for authorization decisions
• Which service lines are subject to authorization and whether that list has expanded since signing
• How appeals and reconsiderations are defined, including who has authority to decide
• Whether authorization requirements were added by policy update rather than amendment
Administrative burden is rarely just administrative. Some of it was negotiated, and some of it could be renegotiated.
