By Dr. Steve Kim, Valer Co-Founder and CEO
This is Part 7 of our 10-part series examining the deep, interconnected complexities that keep prior authorization broken. While many hospital and health systems hope new regulation (CMS-0057-F) and AI will improve processes, the real barriers to progress lie in systemic challenges that span technology, workforce, regulation, and operations. These barriers won’t be eliminated by regulation, payer pledges, or today’s AI solutions—but providers have more control than they might think. Throughout the series, we’ll break down the entire prior auth landscape and include practical recommendations that can make a difference.
Your patient access team has successfully submitted a prior authorization with all required documentation. The portal confirms receipt. Now comes what should be a straightforward waiting period for the payer’s decision. Except it’s not straightforward at all.
Staff often have no reliable way to track authorization status without manually checking payer portals daily, sitting on hold with payer call centers, or hoping that status updates arrive via email before they become buried in overflowing inboxes. Authorizations fall into a black hole where nobody knows whether they’re still under review, approved but not yet visible in systems, or denied without notification.
This status tracking gap creates cascading problems for scheduling, patient communication, and care delivery. When staff can’t reliably determine authorization status, they can’t confidently schedule procedures, can’t give patients clear answers about timing, and risk discovering denials only after services are already delivered.
Challenge #1: Manual Status Checking Consumes Enormous Time
As noted, once an authorization is submitted, staff must actively monitor for decisions rather than being proactively notified. This means logging into multiple payer portals daily to check dozens of pending authorizations, each requiring navigation through different portal interfaces with varying levels of clarity about the status of claims.
This manual checking becomes extraordinarily time-intensive when multiplied across hundreds of pending authorizations and multiple payers. Staff who should be processing new authorizations instead spend hours each day checking status on previously submitted ones. The opportunity cost is enormous—time spent checking status is time not spent managing new authorizations or facilitating other processes for patients.
The solution: Implement automated status tracking that gives patient access staff one single place to monitor authorizations across all payer portals. This shifts staff from reactive checking to exception-based management, and streamlines their workflow so that they are not jumping around between multiple platforms or relying on manual phone calls that disrupt their day.
Challenge #2: No Real-Time Updates in Clinical Workflows
Even when authorization statuses change in payer portals, this information rarely flows back into EHR systems where clinical teams work. Physicians and schedulers operate with stale information, unaware that authorizations have been approved, denied, or are still pending.
This disconnect creates dangerous coordination failures. Surgeons may believe an authorization is approved when it’s actually still pending. Schedulers may book procedures assuming authorization status hasn’t changed, only to discover denial after the patient has already been prepared for the service. Clinical staff waste time preparing for services that can’t proceed due to authorization issues they don’t know about.
The information gap also affects patient communication. When patients call asking about procedure scheduling, staff often can’t provide definitive answers because they don’t have current authorization status information readily available. This creates frustration and erodes patient confidence in the organization’s ability to coordinate their care.
Authorization information often lives in sticky notes, email threads, or Word documents rather than in systems accessible to everyone who needs the information. This ad-hoc tracking creates single points of failure where critical status information is known to one person but not shared systematically across the care team.
The solution: Integrate authorization status tracking directly into EHR workflows where clinical and scheduling teams access patient information. Valer provides a single platform that monitors authorization statuses across all the various portals and then pushes critical data back to the EHR. Authorization status updates should be visible to everyone involved in care coordination without requiring separate portal logins or manual communication.
Challenge #3: Risk of Transcription Errors
When authorization decisions are finally obtained, staff must manually transcribe complex information into billing systems and scheduling platforms. Authorization numbers that may be 15-20 characters long, specific CPT codes, date ranges, and approved quantities must all be entered accurately.
Each manual data entry point creates opportunities for errors that can have serious consequences. A single transposed digit in an authorization number can result in claim denial despite valid authorization. Incorrect date ranges may lead to services being scheduled outside the authorized timeframe. Wrong procedure codes may mean the authorization doesn’t match the actual service delivered.
These transcription errors often aren’t discovered until claims are processed, weeks or months after services are delivered. By then, correcting the error requires retrospective authorization requests or appeals processes that consume significant time and may not be successful.
The risk multiplies when staff are working quickly through high volumes of authorizations. Under time pressure to check multiple pending authorizations and process new submissions, the likelihood of transcription errors increases precisely when the volume makes such errors most costly.
The solution: Eliminate manual transcription wherever possible through automated data transfer between payer systems and internal billing/scheduling platforms. When manual entry is unavoidable, implement verification processes that flag potential errors before they impact claims processing.
Challenge #4: No Standard Expectations for Turnaround Times
Different payers operate on wildly different timelines. Some respond within hours for routine services. Others take weeks for specialty procedures requiring medical director review. Emergency authorization pathways exist in theory but may not actually expedite decisions in practice.
Turnaround times also vary dramatically by service line and specialty. A prior authorization for chemotherapy might be approved within 24 hours, while authorization for a complex surgery could take 15 business days. Within the same payer, different lines of business may have different turnaround time standards—with Medicare Advantage, commercial, and Medicaid authorizations each operating on separate timelines.
This variability makes workforce planning nearly impossible. Staff can’t accurately estimate how long authorization processes will take, making it difficult to set patient expectations or plan scheduling timelines. Clinical teams don’t know whether they should wait a few days or a few weeks before following up on pending authorizations.
The lack of standardization also makes it difficult to identify problematic outliers. When turnaround times vary so dramatically across payers and service types, how do staff distinguish between normal processing delays and authorizations that are truly stuck? Without clear benchmarks, staff may wait too long to escalate slow-moving authorizations or may prematurely escalate authorizations that are simply following typical processing timelines.
Regulations incorporated in CMS 0057F starting January 2026 will attempt to mandate turnaround times (72 hours for urgent, 7 calendar days for routine), but enforcement may be inconsistent, and self-insured and commercial employer plans remain exempt from these requirements entirely.
The solution: Track turnaround times systematically across payers, service lines, and authorization types to establish organization-specific benchmarks. Use this data to identify which authorizations warrant proactive follow-up and to hold payers accountable for excessive delays. Share turnaround time data with clinical teams so they can set realistic patient expectations.
The Compounding Effect of Status Uncertainty
Authorization status uncertainty doesn’t exist in isolation—it compounds every other prior authorization challenge. When staff don’t know authorization status:
- Scheduling becomes guesswork rather than systematic;
- Patient communication becomes vague and undermines confidence;
- Resource planning becomes impossible because teams can’t predict when services will actually occur;
- Denial risk increases because staff may proceed with services assuming authorizations are approved when they’re actually still pending; and
- Staff frustration grows as they feel powerless to get clear answers about authorization status.
Taking Control of Status Tracking
While payers control authorization timelines and decision-making processes, provider organizations aren’t powerless. Technology solutions that aggregate authorization status across multiple payers, provide proactive alerts, and integrate with clinical workflows can dramatically reduce the burden of manual status checking.
The goal isn’t to eliminate status tracking work entirely—that’s impossible given current payer systems—but to make it exception-based rather than routine. Staff should focus their attention on authorizations that are truly stuck or approaching critical timing thresholds, not on routine status checks that could be automated. When clinical teams have reliable, current authorization status information, they can schedule more efficiently, communicate more clearly with patients, and avoid the costly surprises that come from operating with stale information.
Next up in Part 8: How the appeals process functions—or doesn’t—and what provider organizations can do to advocate for their patients and efficiently follow up on denials.
Frequently Asked Questions About Prior Authorization Status Tracking
How long should I wait for a prior authorization decision?
There’s no universal answer—turnaround times vary dramatically by payer, insurance type, service line, and whether the authorization requires medical director review. As of January 1, 2026, Medicare Advantage, Medicaid, CHIP and Qualified Health Plans on the Federally Facilitated Exchanges must respond within 72 hours for expedited requests and days for standard requests. Many state regulations require commercial payers to respond within 2-5 business days for routine services, though enforcement varies. For complex procedures requiring medical director review, authorization decisions may take 10-15 business days or longer. Track turnaround times by payer and service type in your organization to establish realistic expectations.
What should I do if a prior authorization has been pending for too long?
First, determine what “too long” means for your specific situation based on payer standards and regulatory requirements. Check the payer portal to confirm the authorization is still under review and hasn’t been approved or denied without notification. If it exceeds regulatory or contractual timeframes, contact the payer’s provider relations team. Document all follow-up attempts with dates and names of payer representatives. Consider implementing technology that automatically flags all authorization statuses in one single platform for your patient access team.
How can I improve authorization status tracking in my organization?
Implement centralized tracking systems rather than relying on individual staff to monitor pending authorizations across multiple payer portals. Use technology that can automatically check payer portals and alert staff when statuses change or when authorizations have been pending beyond expected timeframes. Integrate authorization status information into your EHR so clinical teams can access current information without separate logins. Establish clear protocols for who is responsible for monitoring authorizations and at what intervals. Track turnaround time metrics by payer to identify systematic delays and hold payers accountable for excessive processing times.
