The Prior Authorization Burden

According to the American Medical Association, physicians and their staff spend an average of 14 hours per week on prior authorization tasks. That's nearly half a day per physician per week spent on administrative work instead of patient care.

For a medical group with 50 physicians, that represents 700 staff-hours per week — or the equivalent of nearly 18 full-time employees dedicated solely to PA tasks.

How Automation Works

AI-powered prior authorization platforms like ReferralPoint's Auto PriorAUTH™ connect directly to payer systems via API. When a referral is submitted, the system:

  1. Identifies whether PA is required based on payer rules, specialty, and diagnosis codes
  2. Pre-populates the submission with patient demographics, clinical notes, and supporting documentation from the EHR
  3. Submits directly to the payer without requiring portal login or manual data entry
  4. Monitors approval status and notifies staff automatically when a decision is received

The CMS Mandate Factor

CMS's Interoperability and Prior Authorization Final Rule (CMS-0057-F) requires payers to implement Prior Authorization APIs by January 2027. This means that the infrastructure for automated PA submission is being mandated across Medicare Advantage, Medicaid, and CHIP plans.

Organizations that invest in automation now will be positioned to take full advantage of this infrastructure from day one.

Results from Automated PA

  • 97% first-pass approval rate when submissions include complete, structured data
  • 90% reduction in PA-related staff time
  • 2-3 day reduction in average approval turnaround
  • Near-zero abandonment due to PA delays

Getting Started

Prior authorization automation doesn't require a full platform replacement. ReferralPoint integrates with existing EHR systems via standard APIs (Epic, Cerner, athenahealth, and others), allowing organizations to add PA automation without disrupting existing clinical workflows.