How automation helps practices with prior authorization

Tackling the growing burden of prior authorizations

Prior authorization remains one of the most persistent administrative challenges in healthcare. For practice managers, it sits at the intersection of clinical care, revenue cycle performance, and staff productivity, often slowing all three.

Today’s medical practices face a growing volume of authorization requirements, constantly shifting payer rules, and increasing pressure to do more with fewer resources. Each payer may have different criteria, documentation standards, and submission processes, many of which change frequently. This creates a complex, time-consuming environment where staff must constantly track updates, verify requirements, and follow up on requests.

The strain of prior authorization has only intensified in recent years. According to the American Medical Association’s latest survey data, physicians and their staff complete an average of nearly 40 prior authorizations per physician, per week.¹ More than nine in 10 doctors report that these requirements delay care and negatively impact patient outcomes.²

For practice managers, the burden shows up in several ways:

• Manual, repetitive work: Staff spend hours submitting requests, tracking status, and following up with payers.
• Unclear or changing requirements: Each payer may have different rules, which are frequently updated and difficult to track.
• High risk of denials: Missing or incorrect authorization details can result in denied claims and lost revenue.
• Communication gaps: Practices often rely on phone calls, faxes, or patient-provided information to confirm requirements.

These inefficiencies can delay care, frustrate patients and clinicians, and create financial strain for practices. As administrative workloads continue to grow, incremental process improvements are no longer enough.

That’s why many organizations are turning to automation — particularly AI-powered, workflow-integrated solutions — to reduce manual work and bring greater consistency and visibility to the authorization process. Platforms like athenaOne® Authorization Management, along with newer capabilities such as Express Authorizations, are designed to help practices streamline workflows from request to approval and better manage the growing burden of prior authorization.

How automation streamlines authorization workflows

Automation is transforming prior authorization from a reactive, manual process into a proactive, streamlined workflow. Within athenaOne, several key capabilities work together to reduce friction and improve efficiency.

Authorization Determination Engine

One of the biggest challenges in prior authorization is simply knowing when it’s required. athenaOne's Authorization Determination Engine addresses this by providing real-time insights — powered by payer integrations, expert research, and artificial intelligence (AI) — to determine whether an authorization is needed at the point of order.

This exception-based approach means staff won’t waste time chasing authorizations that aren’t required. Instead, they can focus only on the cases that truly need attention, accelerating turnaround times and reducing unnecessary workload.

Inbound referral authorizations

For specialists, incomplete or unclear referral information can create delays before a patient even walks through the door. With automation showing all of the details on inbound referral authorizations, providers can see upfront whether a referred patient requires prior authorization and whether it has been completed.

This information is embedded directly into athenaOne's workflows, eliminating guesswork and reducing the need to call payers or rely on patients for details. The result is a smoother intake process and fewer scheduling delays.

Authorization tracker

Managing multiple authorization requests across providers, payers, and service types can quickly become overwhelming. A centralized authorization tracker brings all tasks into one place, allowing staff to: 

• Prioritize work based on urgency
• Filter and customize views
• Update statuses in real time

This centralized approach reduces errors, improves accountability, and gives practice managers better visibility into workload and performance.

Express Authorizations: Intelligent automation in action

Prior authorization often involves multiple handoffs, inconsistent requirements, and time-consuming manual steps that can slow down care and increase administrative burden. Staff must navigate fragmented systems, track down missing information, and manage requests across different payers — all while trying to keep workflows moving.

Tools designed to address these challenges focus on reducing friction, improving visibility, and minimizing unnecessary work. For example, more advanced solutions aim to surface relevant authorization details earlier in the process, streamline documentation, and integrate tasks directly into existing workflows so staff don’t have to switch between systems.

Within this context, athenahealth’s Express Authorizations — introduced in fall 2025 as part of athenaOne’s authorization management suite — brings together several of these capabilities. As an optional add-on, it helps simplify administrative steps by presenting key information at the point of need and supporting more consistent, efficient handling of authorization requests. 

Key capabilities of Express Authorizations include: 

• Centralized, customizable tools: Staff can view, sort, and assign authorization tasks by provider, payer, order type, and more, tailoring workflows to their practice’s needs.
• Simplified data entry and documentation: Consistent, streamlined inputs reduce errors and save time.
• Embedded visibility across workflows: Authorization details appear where they matter most, including ordering, scheduling, and in administrative views.

Rather than relying on manual review alone, Express Authorizations uses automation and payer data to help guide decision-making within the workflow. Drawing on continuously updated payer intelligence, it supports practices in:

• Identifying which orders are likely to require authorization
• Clarifying the steps needed to obtain approvals
• Reducing unnecessary work through exception-based workflows

In 2024 alone, the underlying Authorization Determination Engine incorporated more than 1,300 updates and supported insights across hundreds of payers, ensuring practices are working with the most current information available.³

Automation reduces prior authorization burden, accelerates patient access to care, can help close care and diagnosis gaps, and improves patient satisfaction.

Automation benefits for practices and patients

Automation helps practice managers and staff reduce administrative workload, minimize calls and emails to payers, and improve visibility into authorization status, saving hours each week.

Clinicians experience fewer administrative interruptions and greater confidence that approvals are in place. That gives them more time for patient care and documentation and reduces after-hours work, which helps address physician burnout.

For patients, this all translates to faster access to services, fewer delays, and a smoother overall care experience.

athenahealth case studies illustrate how automation can translate into measurable results. At Tryon Medical Partners, a large independent practice, implementing athenaOne Authorization Management helped eliminate as much as 95% of manual prior authorization work. It also reduced denial rates to as low as 1 to 2%, and cut authorization-related overhead by 40%, freeing staff and clinicians to focus more on patient care.*

Meanwhile, Griffin Faculty Physicians saw similarly meaningful gains. By using automated prior authorization, the organization saved approximately 650 staff hours per month.** It reduced the need for time-consuming phone calls to payers, improving both staff satisfaction and patient experience.*

These examples highlight how the right combination of automation and workflow integration can dramatically reduce administrative strain while accelerating access to care.

Looking ahead: The future of authorization management

As payer requirements continue to change, practices that rely on manual processes will struggle to keep up. Automation, especially when powered by AI and embedded directly into clinical and administrative workflows, offe rs a more sustainable path forward.

athenahealth’s approach reflects this shift. By combining intelligent automation, continuously updated payer insights, and seamless workflow integration, athenaOne is helping practices move from reactive authorization management to proactive, streamlined operations.

Looking ahead, continued advancements, such as deeper electronic payer integrations and real-time status updates, will further reduce friction and bring the industry closer to a fully digital authorization ecosystem.

Ready to reduce the prior authorization burden?

Prior authorization doesn’t have to be a bottleneck. With the right technology, practices can reduce administrative strain, improve financial performance, and help patients access care more quickly.

Ready to learn more? Explore how athenaOne Authorization Management and Express Authorizations can help your practice simplify prior authorization and keep care moving.