Prior Authorization

Every delayed auth is delayed revenue. The follow-up cost often exceeds the procedure value.

At 5-15 follow-up calls per authorization, your team burns hours on a single auth that may cover a $200 procedure. We handle prior auth follow-up inside your first-party workflows — status checks, escalations, and approvals — so your staff focuses on care coordination, not hold queues.

The prior auth follow-up trap.

Getting the auth submitted is only half the battle. The other half is the follow-up cycle — 5 to 15 calls per authorization, each requiring hold time and manual documentation. For practices handling hundreds of auths monthly, the cumulative time is staggering.

5-15
Follow-up calls required on average to resolve a single prior auth
34%
Of prior auths result in care delays due to slow payer response
13 hrs
Per week spent by staff on prior auth follow-up alone

Persistent follow-up without the headcount.

Status Checks at Scale

The agent calls payers on a defined cadence — checking auth status, capturing updates, and logging results. No manual calendar reminders. No calls slipping through.

Escalation on Delays

When a payer misses their stated turnaround time, the agent calls back, references the prior interaction and reference number, and requests expedited review.

Auth Number Capture

Once approved, the agent captures the authorization number, effective dates, and any conditions — logged directly to your system so scheduling and billing can proceed immediately.

Denial & Peer-to-Peer Triggers

If an auth is denied, the agent captures the reason, documents the denial, and flags it for your clinical team to determine if a peer-to-peer review or appeal is warranted.

Prior auth results.

41%
Faster Resolution
Reduction in average prior auth resolution time.
3.1x
More Follow-Up Calls
Completed per day vs. manual process.
22%
Fewer Care Delays
Decrease in delays attributed to auth status.
99.2%
Documentation Accuracy
Auth status captured correctly on every call.

See what Operator Labs could recover for your organization.