Prior authorisation is the most reliably disliked administrative process in American healthcare, which makes it an obvious automation target. It is also frequently automated in the wrong place.
Time-and-motion, not assumption
When practices actually instrument the workflow, submission typically accounts for a minority of staff minutes. The majority goes to status chasing, re-submission after a documentation request, and peer-to-peer scheduling. Automating the form fill addresses the visible step and leaves the expensive one untouched.
A sequencing that reflects the data
- Automate status polling first — it is the largest single time sink and the least clinically sensitive.
- Pre-assemble the documentation package from the record before submission, so the first request for records rarely happens.
- Route denials by reason code, not into one queue.
- Track approval rate by payer and service; it tells you where to negotiate, not just where to work harder.
What not to automate
Clinical justification
Generated medical necessity language is both a quality risk and an audit risk. Assemble the evidence automatically; let a clinician write the argument.
Appeals
Appeals succeed on specifics. Templated appeals are rejected at a materially higher rate, and the rework erases the time saved.
