The Prior Auth Overhaul That Cut 22 Days to One Week

Overview

A small but rapidly expanding pain management group in the Midwest, operating with four providers across two clinic locations, was experiencing significant delays in prior authorization processing. Despite using an EHR-integrated workflow, their average turnaround time had stretched to 22 days.

High volumes of authorizations for lumbar injections, RFAs, stimulators, advanced imaging, and conservative therapy validations were getting stuck at various stages. Patients faced long waits, procedures had to be rescheduled, and providers struggled to maintain consistent care plans and predictable revenue cycles. What initially seemed like slow payer response times ultimately revealed deeper workflow and documentation challenges inside the practice.

Challenges

Fragmented Workflow

Although the group focused solely on pain management, each provider’s team initiated authorizations using different intake habits and checklists. Some requests were submitted with notes still pending, while others waited on documentation but lacked clear pre-submission validation. These inconsistencies led to early rework, unnecessary back-and-forth, and delays before a request even reached the payer’s review queue.

Documentation Gaps

Critical information such as conservative treatment history, imaging findings, updated provider notes, and medical necessity rationale was not consistently attached at the time of submission. As a result, payers frequently requested clarifications or additional documentation. Each request added days to the timeline and forced staff to chase missing information that could have been included upfront.

Limited Visibility Into Payer-Specific Rules

Staff relied on memory, past submissions, or old PDFs to determine what different payers required. Without a centralized reference point for Medicare, Medicaid, and commercial plan policies, submissions were often incomplete or misaligned with current criteria. This led to repeated follow-up cycles and last-minute documentation additions as staff discovered requirements late in the process.

Provider and Patient Experience Impact

These delays created scheduling uncertainty and added pressure on clinical and administrative teams. Patients made frequent calls for updates, and schedulers were forced to push out appointments or hold time slots open. Providers found it increasingly challenging to plan treatment sequences, and the administrative workload continued to grow as follow-up demands increased.

AnnexMed’s Strategy

Centralized Prior Authorization Desk

AnnexMed streamlined the group’s entire authorization process by creating a single coordinated desk that managed every request from intake to approval. All cases followed one standardized checklist regardless of provider or procedure type. This consistency eliminated unnecessary variations in workflow and ensured that each request began with complete, verified information.

Payer Intelligence and Rules-Aligned Submission

AnnexMed introduced a real-time payer policy reference that gave the team immediate visibility into coverage criteria across all major insurance plans. Every authorization was screened against these rules before submission, confirming that clinical notes, medical necessity details, imaging references, conservative therapy evidence, and coding were all aligned. This proactive approach shifted the practice from reactive problem-solving to confident, first-pass submissions.

Clinical Documentation Strengthening

Working closely with the providers, AnnexMed developed structured templates specifically for pain management. These guides helped physicians clearly document symptom progression, failed therapies, diagnostic findings, and functional impact in their notes. As a result, requests were far more complete and compelling for initial payer review, reducing the likelihood of clarification calls.

Performance Tracking With Escalation Controls

A simple, real-time dashboard gave the practice full visibility into pending requests, payer timelines, aging cases, and high-priority procedures. If a case reached a threshold where action was needed, escalation was triggered automatically. This ensured that no authorization stalled silently and that all stakeholders knew exactly where each case stood at any given moment.

Solution Impact

22 -> 7

reduced PA turnaround

1.5 days

saved per provider per week

46%

fewer patient reschedules

94%

first-pass submission accuracy

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