Handling Prior Authorizations Effectively

by | Last updated Oct 4, 2023 | Published on Oct 27, 2014 | Insurance Verification and Authorizations

Prior Authorization
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Dealing with prior authorizations effectively improves patient outcomes by ensuring that they receive the most appropriate medications, while reducing waste, error and unnecessary prescription drug use and cost. Efficient and effective use of health care resources can minimize overall medical costs, improve health plan member access to more affordable care and enhance quality of life.

Keys to Success with Pre-authorization

Here are success strategies recommended by experts to obtain the approvals from insurance companies:

    • Best practices to contact the insurance company – It is not easy for the physician or his staff to find the time to call the doctor appointed by the insurance company and discuss the need for the required service. Nevertheless such calls need to be made. Another more viable option is to go to the payer’s website to get prior authorizations whenever possible. This can generate a quicker response and avoid wastage of time on telephone calls, where you may be put on hold.


    • Assign the task to specialists – Putting one or two of your employees in charge of prior authorizations is a practical solution as these individuals will become experts in handling the process and develop smooth relationships with the payers. Alternatively, when you don’t have staff members to spare, you can assign the task to a medical billing company which would have a dedicated team to handle the process.


    • Minimize the number of prior authorization requests: For medications, see that you or whoever is handling the procedure is familiar with insurers’ formularies. Develop a list of drugs covered for common diseases. This will help you get into the practice of prescribing that drug, appropriate for the patient, which does not require a preauthorization request.


  • Have forms ready: Make sure the forms for the drugs and procedures that most commonly require a prior authorization are readily and easily available in your computers or as hard copies. This will save a lot of time when a prior authorization alert arrives.

Physicians are very busy people and insurance verification and prior authorization can take up a lot of time and resources. That’s why many doctors outsource the tasks to a professional medical billing company. With a team of experienced insurance verification specialists, a reliable company can assure in cleaner claims and improved practice efficiency. The health insurance verification and preauthorization services they provide lessens physician workload and helps them to focus on their core business of ensuring timely and appropriate care. Prior authorizations are unavoidable part of running a medical practice and support from a healthcare business process outsourcing company can help reduce the time and financial burdens associated with these activities.

  • Natalie Tornese
    Natalie Tornese
    CPC: Director of Revenue Cycle Management

    Natalie joined MOS’ Revenue Cycle Management Division in October 2011. She brings twenty five years of hands on management experience to the company.

  • Meghann Drella
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  • Loralee Kapp
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