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As part of our mission to simplify and speed prior authorization submissions, we are closely tracking the regulatory landscape to understand how changes will affect providers. After much uncertainty and many piecemeal regulatory updates, we are on the cusp of a larger shift with CMS-0057-F, which attempts to standardize prior auth processes and increase transparency about payer ruling patterns.
Prior authorization is time consuming, complex, and expensive—at best. On average, one prior authorization, alone, takes 22 minutes to complete and costs provider organizations nearly $11. At worst, prior authorization is a hazard. It can impede delivery of timely and potentially life-saving patient care, limit protocol and care journey options, and contribute to burnout for clinical and administrative staff. It also compromises the financial health of provider organizations.
2024 raised questions about the current state of prior authorization processes. In this blog, we’ll walk through a few of the most important trends that came to light last year and how prior authorization automation can come into play to streamline the process for your organization in 2025.
