KPIs to Measure with Your Prior Authorization Software
How are you measuring your team’s prior authorization management performance? Not measuring anything today? Don’t worry, you’re not alone.
Just because you’re not measuring prior authorization management today doesn’t mean you shouldn’t. After all, prior authorizations are the single largest cause for claim denials at most healthcare organizations, on average accounting for almost 50% of all denied claims. Prior authorization complexity and delays are also a common cause for patient abandonment of treatments and procedures.
So why don’t most healthcare organizations measure their prior authorization management? Two key reasons. One, organizations often don’t have technology to enable them to measure prior authorization KPIs. Worse than not having a tool to measure KPIs, healthcare organizations often don’t even know what to measure. If high-performing prior authorization management is defined as getting payer approvals quickly and efficiently, what are the leading indicators against those objectives?
Here are the essential KPIs we recommend our healthcare partners monitor so they can be confident they’re getting the most out of their prior authorization software.
1. Authorization Turnaround Times
Time is critical when it comes to prior authorization management. Delays not only impact patient care and satisfaction but also disrupt workflows. Measuring turnaround times allows you to identify bottlenecks in the process, whether they occur at the submission stage, payer response time, or after approval decisions have been made. By leveraging prior authorization automation software, for instance Valer, you can continuously monitor performance, expedite the approval process, and reduce the time it takes for patients to receive necessary treatments or medicines. Faster turnaround times enhance patient outcomes and improve your practice’s reputation.
Why It Matters: Streamlining approval times not only enhances patient care but also boosts staff productivity by reducing follow-up efforts.
2. Approval Rates
High denial rates often signal inefficiencies or errors in submission or payer-specific requirements. By monitoring approval rates, you can refine your prior authorization workflow, ensuring that submissions are aligned with payer guidelines. Your prior authorization software should offer insights into which payers or services result in the highest denial rates, allowing you to improve documentation and streamline workflows. An automated prior authorization software should also help decrease the risk of errors with manual data entry, further reducing the risk of prior authorization denial.
Why It Matters: Increasing approval rates improves the patient experience, reduces administrative burden, and fosters trust between your organization and payers. Increased approval rates also mean you can cut down on costly appeals processes – directly impacting the bottom line.
3. Staff Productivity
By automating routine tasks like document submission, status checks, and EHR synchronization, prior authorization software frees up your staff to focus on higher-value tasks. A good KPI to monitor here is the amount of time staff spends on prior auth tasks before and after implementing the solution. Measuring the number of authorizations handled per employee or the reduction in manual tasks provides tangible evidence of software ROI.
Why It Matters: Tracking staff productivity helps ensure your team operates efficiently, increasing their capacity to handle more authorizations and improving job satisfaction.
4. Payer Performance
All payers are not created equal. Some might consistently respond within a day, while others could take longer – delaying patient care and causing frustration. Tracking payer performance gives you a clear picture of which payers facilitate a smooth prior authorization process, and which create delays. However, beginning primarily in 2026, there are new requirements for payer decision timelines.
CMS recently finalized a rule that will require payers to send prior authorization decisions within 72 hours for expedited requests and seven calendar days for standard (non-urgent) requests for medical items and services. For some payers, this new ruling also requires them to include a specific reason for denying a prior auth request, which will help facilitate resubmission of the request or an appeal when needed. This information can be a powerful tool during payer negotiations, providing factual data that can help advocate for better contract terms or quicker turnaround times.Â
Why It Matters: By understanding payer performance, you can optimize your relationships with insurance companies and negotiate based on hard data, leading to better long-term outcomes for both your organization and your patients.
Maximizing the Value of Your Prior Authorization Software
Measuring these KPIs isn’t just about tracking data – it’s about creating a continuous cycle of operational and patient care improvement. By monitoring turnaround times, approval rates, staff productivity, and payer performance, you gain actionable insights that help optimize your workflows and empower your team.
With a prior authorization automation solution like Valer, you gain access to robust real-time reporting. Data-driven decision-making becomes more accessible with comprehensive reporting functionalities. If you’re ready to see firsthand how we can streamline your prior authorization process, get in touch today.
