How to Reduce Prior Authorization Delays: Root Causes, Data, and Proven Strategies
How to Reduce Prior Authorization Delays: Root Causes, Data, and Proven Strategies
Tuesday, February 3, 2026
Tuesday, February 3, 2026
The PA Problem Is Growing
Practices now complete an average of 39 prior authorizations per physician per week. That's up 34% from 2022, when the average was 29. The 2024 AMA Prior Authorization Physician Survey found that this workload consumes 13 hours of staff time weekly, and 93% of physicians report that PA delays necessary patient care.
The consequences go beyond administrative burden. More than 25% of physicians report that PA has led to a serious adverse event for a patient in their care. 23% report a hospitalization caused by PA delays.
These aren't abstract statistics. They're patients waiting days or weeks to start treatment. Staff working overtime to chase approvals. Clinicians spending time on paperwork instead of patient care.
What follows is a breakdown of where PA delays actually happen, what they cost, and seven concrete strategies to reduce turnaround time - from operational fixes you can implement this week to technology investments that compress days into minutes.
Practices now complete an average of 39 prior authorizations per physician per week. That's up 34% from 2022, when the average was 29. The 2024 AMA Prior Authorization Physician Survey found that this workload consumes 13 hours of staff time weekly, and 93% of physicians report that PA delays necessary patient care.
The consequences go beyond administrative burden. More than 25% of physicians report that PA has led to a serious adverse event for a patient in their care. 23% report a hospitalization caused by PA delays.
These aren't abstract statistics. They're patients waiting days or weeks to start treatment. Staff working overtime to chase approvals. Clinicians spending time on paperwork instead of patient care.
What follows is a breakdown of where PA delays actually happen, what they cost, and seven concrete strategies to reduce turnaround time - from operational fixes you can implement this week to technology investments that compress days into minutes.
Where Delays Happen and What They Cost
Here's where time gets lost in the PA lifecycle:
Step | What Happens | Where Time is Lost | Typical Delay |
|---|---|---|---|
1. PA requirement discovery | Checking if PA is needed | Manual payer portal lookups, outdated formulary data | Hours to 1 day |
2. Documentation gathering | Collecting chart notes, labs, prior treatments | Chasing providers, incomplete records, fax workflows | 1-3 days |
3. Submission | Sending PA request to payer | Wrong form, missing fields, fax/phone submission | Hours to 1 day |
4. Payer review | Clinical team evaluates request | Opaque queue, no status visibility, variable workload | 2-10 days |
5. Follow-up | Payer requests more documentation | Notification delays, re-gathering clinical data | 1-5 days |
6. Appeal (if denied) | Resubmission with additional justification | 31% of PAs are "often" or "always" denied initially | 5-15 days |
Total: 2-30+ days from prescription to approval, depending on complexity and whether you get denied.
The AMA survey found that 31% of physicians report their requests are "often" or "always" denied on initial submission. Each denial adds days and requires additional staff effort.
Note: Step-level estimates are editorial, informed by AMA data, Surescripts benchmarks, and vendor case studies. Your mileage will vary.
The Cost of PA Delays
The impact touches clinical outcomes, workforce wellbeing, patient experience, and the bottom line.
Clinical Impact
93% of physicians say PA delays access to necessary care
25%+ report PA has led to a serious adverse event
23% report a hospitalization caused by PA delays
Workforce Impact
89% say PA increases clinician burnout
40% have staff working exclusively on PA
13 hours per physician per week spent on PA
Patient Impact
60%+ abandonment rate when out-of-pocket costs exceed $500
Nearly 40% of specialty prescriptions are never filled
PA delays compound cost uncertainty - patients don't know their final cost until authorization is confirmed
Financial Impact
$25-$118 to rework a denied claim
14-18% of all denials relate to eligibility/authorization errors
12% overall claim denial rate
Sources: 2024 AMA survey; IQVIA 2020; BrightInsight/Claritas Rx; HFMA 2021; CAQH 2023-2024
The business case is clear: every day shaved from turnaround time reduces staff costs, improves outcomes, and increases the likelihood that patients actually start therapy.
Here's where time gets lost in the PA lifecycle:
Step | What Happens | Where Time is Lost | Typical Delay |
|---|---|---|---|
1. PA requirement discovery | Checking if PA is needed | Manual payer portal lookups, outdated formulary data | Hours to 1 day |
2. Documentation gathering | Collecting chart notes, labs, prior treatments | Chasing providers, incomplete records, fax workflows | 1-3 days |
3. Submission | Sending PA request to payer | Wrong form, missing fields, fax/phone submission | Hours to 1 day |
4. Payer review | Clinical team evaluates request | Opaque queue, no status visibility, variable workload | 2-10 days |
5. Follow-up | Payer requests more documentation | Notification delays, re-gathering clinical data | 1-5 days |
6. Appeal (if denied) | Resubmission with additional justification | 31% of PAs are "often" or "always" denied initially | 5-15 days |
Total: 2-30+ days from prescription to approval, depending on complexity and whether you get denied.
The AMA survey found that 31% of physicians report their requests are "often" or "always" denied on initial submission. Each denial adds days and requires additional staff effort.
Note: Step-level estimates are editorial, informed by AMA data, Surescripts benchmarks, and vendor case studies. Your mileage will vary.
The Cost of PA Delays
The impact touches clinical outcomes, workforce wellbeing, patient experience, and the bottom line.
Clinical Impact
93% of physicians say PA delays access to necessary care
25%+ report PA has led to a serious adverse event
23% report a hospitalization caused by PA delays
Workforce Impact
89% say PA increases clinician burnout
40% have staff working exclusively on PA
13 hours per physician per week spent on PA
Patient Impact
60%+ abandonment rate when out-of-pocket costs exceed $500
Nearly 40% of specialty prescriptions are never filled
PA delays compound cost uncertainty - patients don't know their final cost until authorization is confirmed
Financial Impact
$25-$118 to rework a denied claim
14-18% of all denials relate to eligibility/authorization errors
12% overall claim denial rate
Sources: 2024 AMA survey; IQVIA 2020; BrightInsight/Claritas Rx; HFMA 2021; CAQH 2023-2024
The business case is clear: every day shaved from turnaround time reduces staff costs, improves outcomes, and increases the likelihood that patients actually start therapy.
Strategies 1-3: Discovery, Documentation, and Electronic PA
These range from operational improvements requiring no technology investment to automation that requires vendor partnerships. Most organizations implement several simultaneously.
Automate PA Requirement Discovery
Staff manually check payer portals or call payer lines to determine whether PA is required for a specific drug or procedure. This often happens after prescribing, creating delays before the PA process even begins.
The fix: real-time eligibility and benefit verification tools that flag PA requirements at the point of prescribing. When clinicians know PA is required before writing the prescription, the process can start immediately.
CMS-0057-F will require payers to expose PA requirement data via FHIR APIs by January 1, 2027 - this will enable EHR-integrated tools to surface requirements automatically during clinical workflows.
To implement: Evaluate eligibility software with PA flagging, integrate alerts into EHR prescribing workflows, train staff to initiate PA immediately when requirements are flagged.
Pre-Build Documentation Packages by Therapy Area
Gathering clinical documentation takes 1-3 days on average. Staff chase chart notes, lab results, and prior treatment history from multiple sources.
The fix: standardize the clinical data each payer needs for common therapies. Create "PA packets" by drug class with required elements pre-identified.
To implement: Identify your top 10-20 medications by PA volume. Document payer-specific requirements for each. Create templates staff can populate quickly. Store documentation in the EHR where it's easily accessible.
For biologics, for example, your template might include: diagnosis with ICD-10 code, prior treatment history (which conventional therapies were tried and failed), relevant lab results, prescriber attestation of medical necessity. Having this structure pre-defined can reduce documentation gathering from days to hours.
Switch from Fax/Phone to Electronic PA
Fax-based PA involves sending paper documents, waiting for payer receipt confirmation, and following up by phone. Phone submission means hold times averaging 30+ minutes and manual data entry on both ends.
Electronic PA routes requests digitally and returns decisions through the same channel. Eliminates transmission delays and provides status visibility.
The numbers:
Standard ePA via Surescripts cuts median decision time from 18.7 hours to 5.7 hours
Touchless PA (when criteria are met and evaluated automatically): 22-27 seconds
CVS Caremark ePA: 5.9 minutes (Medicare Part D), 7.5 minutes (Commercial) - vs. hours or days via fax
To implement: Verify your EHR supports NCPDP SCRIPT for prescription ePA. Check payer participation in electronic PA networks. Train staff on electronic submission. Set adoption targets and track progress.
One caveat: "electronic" doesn't mean instant. Many electronic submissions still route through payer review queues. But eliminating transmission delays and enabling status tracking makes a real difference.
These range from operational improvements requiring no technology investment to automation that requires vendor partnerships. Most organizations implement several simultaneously.
Automate PA Requirement Discovery
Staff manually check payer portals or call payer lines to determine whether PA is required for a specific drug or procedure. This often happens after prescribing, creating delays before the PA process even begins.
The fix: real-time eligibility and benefit verification tools that flag PA requirements at the point of prescribing. When clinicians know PA is required before writing the prescription, the process can start immediately.
CMS-0057-F will require payers to expose PA requirement data via FHIR APIs by January 1, 2027 - this will enable EHR-integrated tools to surface requirements automatically during clinical workflows.
To implement: Evaluate eligibility software with PA flagging, integrate alerts into EHR prescribing workflows, train staff to initiate PA immediately when requirements are flagged.
Pre-Build Documentation Packages by Therapy Area
Gathering clinical documentation takes 1-3 days on average. Staff chase chart notes, lab results, and prior treatment history from multiple sources.
The fix: standardize the clinical data each payer needs for common therapies. Create "PA packets" by drug class with required elements pre-identified.
To implement: Identify your top 10-20 medications by PA volume. Document payer-specific requirements for each. Create templates staff can populate quickly. Store documentation in the EHR where it's easily accessible.
For biologics, for example, your template might include: diagnosis with ICD-10 code, prior treatment history (which conventional therapies were tried and failed), relevant lab results, prescriber attestation of medical necessity. Having this structure pre-defined can reduce documentation gathering from days to hours.
Switch from Fax/Phone to Electronic PA
Fax-based PA involves sending paper documents, waiting for payer receipt confirmation, and following up by phone. Phone submission means hold times averaging 30+ minutes and manual data entry on both ends.
Electronic PA routes requests digitally and returns decisions through the same channel. Eliminates transmission delays and provides status visibility.
The numbers:
Standard ePA via Surescripts cuts median decision time from 18.7 hours to 5.7 hours
Touchless PA (when criteria are met and evaluated automatically): 22-27 seconds
CVS Caremark ePA: 5.9 minutes (Medicare Part D), 7.5 minutes (Commercial) - vs. hours or days via fax
To implement: Verify your EHR supports NCPDP SCRIPT for prescription ePA. Check payer participation in electronic PA networks. Train staff on electronic submission. Set adoption targets and track progress.
One caveat: "electronic" doesn't mean instant. Many electronic submissions still route through payer review queues. But eliminating transmission delays and enabling status tracking makes a real difference.
Strategies 4-5: AI Automation and Metrics
Implement AI-Powered PA Automation
Even with electronic submission, staff still compile documentation, complete forms, submit requests, track status, and handle follow-up. This is where that 13 hours per physician per week goes.
AI platforms can automate the complete PA lifecycle: gathering clinical documentation from the EHR, generating PA requests, submitting to payers, monitoring status, responding to information requests.
House Rx reports PA generated in 15 seconds, submitted in under 60 seconds, with 92% first-pass approval. AI platforms generally claim 50-80% reduction in staff time per PA.
These are vendor-reported metrics. Ask for reference customers with similar patient populations when evaluating.
To implement: Evaluate AI PA platforms based on your therapy mix and payer coverage. Start with high-volume, high-delay medications where ROI is clearest. Measure baseline metrics before implementation. Plan for staff redeployment as automation handles routine work.
For platform comparisons, see our guide: Electronic Prior Authorization Platforms Compared.
Track and Benchmark Your Metrics
Many organizations don't actually know their PA performance. Without data, you can't identify which payers, therapies, or workflow steps create the most delay.
What to track:
Submission-to-decision time (days from submission to approval/denial)
First-pass approval rate
Appeal rate and appeal success rate
Staff hours per PA
Benchmarks:
2024 AMA survey baseline: 39 PAs per physician per week, 13 hours staff time
Surescripts ePA: 5.7 hours median decision time
First-pass approval rates vary by therapy; aim to exceed payer-specific baselines
To implement: Configure PA tracking in your practice management or EHR system. Generate weekly/monthly reports. Identify outliers - which payers or therapies have the worst performance? Set targets and track progress.
Implement AI-Powered PA Automation
Even with electronic submission, staff still compile documentation, complete forms, submit requests, track status, and handle follow-up. This is where that 13 hours per physician per week goes.
AI platforms can automate the complete PA lifecycle: gathering clinical documentation from the EHR, generating PA requests, submitting to payers, monitoring status, responding to information requests.
House Rx reports PA generated in 15 seconds, submitted in under 60 seconds, with 92% first-pass approval. AI platforms generally claim 50-80% reduction in staff time per PA.
These are vendor-reported metrics. Ask for reference customers with similar patient populations when evaluating.
To implement: Evaluate AI PA platforms based on your therapy mix and payer coverage. Start with high-volume, high-delay medications where ROI is clearest. Measure baseline metrics before implementation. Plan for staff redeployment as automation handles routine work.
For platform comparisons, see our guide: Electronic Prior Authorization Platforms Compared.
Track and Benchmark Your Metrics
Many organizations don't actually know their PA performance. Without data, you can't identify which payers, therapies, or workflow steps create the most delay.
What to track:
Submission-to-decision time (days from submission to approval/denial)
First-pass approval rate
Appeal rate and appeal success rate
Staff hours per PA
Benchmarks:
2024 AMA survey baseline: 39 PAs per physician per week, 13 hours staff time
Surescripts ePA: 5.7 hours median decision time
First-pass approval rates vary by therapy; aim to exceed payer-specific baselines
To implement: Configure PA tracking in your practice management or EHR system. Generate weekly/monthly reports. Identify outliers - which payers or therapies have the worst performance? Set targets and track progress.
Strategies 6-7: Gold Carding and Regulatory Leverage
Leverage Gold Carding Where Available
PA requirements apply uniformly regardless of provider approval history. A provider with 99% approval faces the same process as one with 60%. That seems… wrong.
"Gold carding" exempts high-performing providers from PA requirements for certain services. Several states have enacted legislation:
Texas (HB 3459): Providers with 90%+ approval rates exempt
Louisiana: Similar high-performer exemptions
Michigan: Gold carding provisions enacted
Additional states have legislation pending
Check current status with your state medical association - laws continue to evolve.
To implement: Check if your state has gold carding. Track approval rates by payer and service to identify eligibility. Work with payers to apply exemptions. Maintain high approval rates to preserve gold card status.
Prepare for CMS-0057-F (and Use It as Leverage)
Timeline:
January 1, 2026: Reduced response times - 72 hours expedited, 7 days standard
January 1, 2027: FHIR-based PA APIs required for Medicare Advantage, Medicaid/CHIP FFS, Medicaid managed care, QHP issuers
What this means: payers will be forced to make faster decisions. FHIR APIs will enable better integration. Denial reasons must be specific, enabling more targeted appeals.
How to use this strategically: Reference compliance requirements in payer negotiations. Evaluate vendors on FHIR readiness. Plan for reduced PA burden as regulations take effect. Monitor payer compliance and report violations.
Leverage Gold Carding Where Available
PA requirements apply uniformly regardless of provider approval history. A provider with 99% approval faces the same process as one with 60%. That seems… wrong.
"Gold carding" exempts high-performing providers from PA requirements for certain services. Several states have enacted legislation:
Texas (HB 3459): Providers with 90%+ approval rates exempt
Louisiana: Similar high-performer exemptions
Michigan: Gold carding provisions enacted
Additional states have legislation pending
Check current status with your state medical association - laws continue to evolve.
To implement: Check if your state has gold carding. Track approval rates by payer and service to identify eligibility. Work with payers to apply exemptions. Maintain high approval rates to preserve gold card status.
Prepare for CMS-0057-F (and Use It as Leverage)
Timeline:
January 1, 2026: Reduced response times - 72 hours expedited, 7 days standard
January 1, 2027: FHIR-based PA APIs required for Medicare Advantage, Medicaid/CHIP FFS, Medicaid managed care, QHP issuers
What this means: payers will be forced to make faster decisions. FHIR APIs will enable better integration. Denial reasons must be specific, enabling more targeted appeals.
How to use this strategically: Reference compliance requirements in payer negotiations. Evaluate vendors on FHIR readiness. Plan for reduced PA burden as regulations take effect. Monitor payer compliance and report violations.
What's Changing
The PA landscape is transforming through both regulatory pressure and technology.
CMS-0057-F mandates faster decisions and standardized APIs. By 2027, the payer side of PA will look fundamentally different for regulated plans. Commercial plans not subject to the rule may lag, creating a bifurcated landscape.
State reforms continue expanding - gold carding, expedited decision requirements, continuity of care protections. Organizations operating across states need to track varying requirements.
Technology evolution: Early PA automation used RPA to navigate portals and fill forms. Current AI platforms go further - interpreting clinical documentation, generating authorization requests, handling exceptions that would break brittle automation. As payers implement FHIR APIs, real-time PA requirement discovery and decision exchange will become standard.
The trajectory: PA turnaround will compress from days to hours over the next 2-3 years. Organizations investing now will see competitive advantage in staff efficiency and patient experience.
The Bottom Line
PA delays are solvable. The solutions exist - operational improvements you can implement today, technology investments that deliver dramatic reductions.
Start with operational fixes:
Automate PA requirement discovery
Pre-build documentation packages
Track metrics to identify bottlenecks
Apply for gold carding where available
Evaluate technology investments:
Switch from fax to electronic PA
Evaluate AI-powered automation
Plan for regulatory change:
Prepare for CMS-0057-F and use it as leverage
Most organizations are still running workflows designed for a fax-and-phone era. The gap between current state and what's possible represents a real opportunity - better patient outcomes, reduced staff burden, improved financial performance.
For readers evaluating specific platforms, see our comparison of electronic prior authorization solutions.
Sources:
• AMA. "2024 Prior Authorization Physician Survey." American Medical Association, December 2024.
• CMS. "CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) Fact Sheet." January 2024.
• Surescripts. "Electronic Prior Authorization."
• Surescripts. "Touchless Prior Authorization Surpasses 76,000 Prescribers." Press release.
• CVS Caremark. "Prior Authorization Information for Healthcare Professionals."
• House Rx. "House Rx Announces First AI-Enabled Pharmacy Management Platform." PRNewswire, April 2025.
• IQVIA Institute. "Medicine Use and Spending in the U.S." 2020.
• BrightInsight and Claritas Rx. "Abandonment and Discontinuation Variation in Specialty Drugs." 2024.
• CAQH. "2024 CAQH Index Report." 2024.
• CAQH. "2023 CAQH Index Report." 2023.
• HFMA. Healthcare Financial Management Association data on claim rework costs, 2021.
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@ 2025 Neon Health (Belay, Inc).
AI-powered patient access automation
for leading pharma enterprises.